Provider Demographics
NPI:1891867230
Name:JORGENSON, BETTY N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:BETTY
Middle Name:N
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4332 CERRITOS AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ALAMITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90720-2557
Mailing Address - Country:US
Mailing Address - Phone:562-434-7868
Mailing Address - Fax:562-434-7868
Practice Address - Street 1:4332 CERRITOS AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2557
Practice Address - Country:US
Practice Address - Phone:562-434-7868
Practice Address - Fax:562-434-7868
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW4693104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker