Provider Demographics
NPI:1770932600
Name:WOODRUM, JASON MATT (LCSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:MATT
Last Name:WOODRUM
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 CHIANTI
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694-1402
Mailing Address - Country:US
Mailing Address - Phone:714-732-4437
Mailing Address - Fax:
Practice Address - Street 1:18 GARRISON LOOP
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-0605
Practice Address - Country:US
Practice Address - Phone:714-732-4437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-10
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1109711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty