Provider Demographics
NPI:1134767940
Name:LUNA-NGUYEN, JENNIFER KRISTINE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KRISTINE
Last Name:LUNA-NGUYEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:KRISTINE
Other - Last Name:LUNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41 E FOOTHILL BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-2361
Mailing Address - Country:US
Mailing Address - Phone:626-701-4249
Mailing Address - Fax:626-737-6034
Practice Address - Street 1:1333 S MAYFLOWER AVE STE 360
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-5280
Practice Address - Country:US
Practice Address - Phone:626-701-4249
Practice Address - Fax:626-737-6034
Is Sole Proprietor?:Yes
Enumeration Date:2019-12-12
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA907611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA90761OtherLICENSED CLINICAL SOCIAL WORKER