Provider Demographics
NPI:1902220999
Name:GARZA, JACQUELYNE DANIELLE (MSW, ASW)
Entity Type:Individual
Prefix:
First Name:JACQUELYNE
Middle Name:DANIELLE
Last Name:GARZA
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 23129
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92711-3129
Mailing Address - Country:US
Mailing Address - Phone:714-721-1394
Mailing Address - Fax:
Practice Address - Street 1:792 W TOWN AND COUNTRY RD BLDG E
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-4710
Practice Address - Country:US
Practice Address - Phone:714-480-5160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-02-11
Last Update Date:2014-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA355941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical