Provider Demographics
NPI:1801956156
Name:MCKEOWN, JENICA LOREN (LCSW)
Entity type:Individual
Prefix:MISS
First Name:JENICA
Middle Name:LOREN
Last Name:MCKEOWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JENICA
Other - Middle Name:LOREN
Other - Last Name:COHEN-RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2831 CAMINO DEL RIO S STE 203
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3828
Mailing Address - Country:US
Mailing Address - Phone:858-683-3793
Mailing Address - Fax:
Practice Address - Street 1:2831 CAMINO DEL RIO S STE 203
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3828
Practice Address - Country:US
Practice Address - Phone:858-683-3793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-09
Last Update Date:2021-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA620861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health