Provider Demographics
NPI:1922124262
Name:DUCREUX, JAIME (MSW)
Entity Type:Individual
Prefix:
First Name:JAIME
Middle Name:
Last Name:DUCREUX
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1225 S ALTA VISTA AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-5277
Mailing Address - Country:US
Mailing Address - Phone:323-359-2837
Mailing Address - Fax:
Practice Address - Street 1:3125 N BROADWAY
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90031-2703
Practice Address - Country:US
Practice Address - Phone:323-222-4591
Practice Address - Fax:323-222-4614
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6683658101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health