Provider Demographics
NPI:1073948931
Name:FINCH, JACQUELINE WHITE (LCSW)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:WHITE
Last Name:FINCH
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 1:11303 W WASHINGTON BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-6003
Mailing Address - Country:US
Mailing Address - Phone:310-482-6610
Mailing Address - Fax:310-313-0813
Practice Address - Street 1:11303 W WASHINGTON BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90066-6003
Practice Address - Country:US
Practice Address - Phone:310-482-6610
Practice Address - Fax:310-313-0813
Is Sole Proprietor?:No
Enumeration Date:2013-09-11
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65459101YM0800X
CA829961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7420Medicaid
CA7068Medicaid
CA6758Medicaid