Provider Demographics
NPI:1902395130
Name:MARCA, JESSICA ANDREA (MSW)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANDREA
Last Name:MARCA
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JESSICA
Other - Middle Name:ANDREA
Other - Last Name:MARCA RENGIFO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:24628 ZENA CT
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-4736
Mailing Address - Country:US
Mailing Address - Phone:949-282-9211
Mailing Address - Fax:
Practice Address - Street 1:6631 STEPHENS RANCH RD
Practice Address - Street 2:
Practice Address - City:LA VERNE
Practice Address - State:CA
Practice Address - Zip Code:91750-1146
Practice Address - Country:US
Practice Address - Phone:909-593-4926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-03
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW76609101YM0800X
CALCSW1049921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health