Provider Demographics
NPI:1972195808
Name:MORGAN, JARED A (ASW)
Entity Type:Individual
Prefix:
First Name:JARED
Middle Name:A
Last Name:MORGAN
Suffix:
Gender:M
Credentials:ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4221 DUQUESNE AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-2896
Mailing Address - Country:US
Mailing Address - Phone:310-502-2604
Mailing Address - Fax:
Practice Address - Street 1:3861 SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-4605
Practice Address - Country:US
Practice Address - Phone:310-450-2191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA811631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA81163OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES