Provider Demographics
NPI:1942449236
Name:LAINER-VOS, JESSE SHULAMIT (LCSW)
Entity Type:Individual
Prefix:
First Name:JESSE
Middle Name:SHULAMIT
Last Name:LAINER-VOS
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 1:6533 OLYMPIC PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2526
Mailing Address - Country:US
Mailing Address - Phone:646-322-2715
Mailing Address - Fax:
Practice Address - Street 1:6533 OLYMPIC PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90035-2526
Practice Address - Country:US
Practice Address - Phone:646-322-2715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-11
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA114992251S00000X
CA270511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health