Provider Demographics
NPI:1780916718
Name:WOMER, JUSTIN ARTHUR (LCSW)
Entity type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ARTHUR
Last Name:WOMER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:JUSTIN
Other - Middle Name:LINWOOD
Other - Last Name:WOMER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:3995 ROSEBAY ST
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3312
Mailing Address - Country:US
Mailing Address - Phone:909-240-9323
Mailing Address - Fax:
Practice Address - Street 1:686 E MILL ST
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92415-1855
Practice Address - Country:US
Practice Address - Phone:800-451-5633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-01
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10061217101YA0400X
CA811931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)