Provider Demographics
NPI:1811331440
Name:HANEY, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:HANEY
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 1:14781 POMERADO RD # 472
Mailing Address - Street 2:
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2802
Mailing Address - Country:US
Mailing Address - Phone:858-204-2883
Mailing Address - Fax:858-224-1084
Practice Address - Street 1:14781 POMERADO RD # 472
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2802
Practice Address - Country:US
Practice Address - Phone:858-204-2883
Practice Address - Fax:858-224-1084
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-25
Last Update Date:2021-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA283291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA28329OtherCALIFORNIA BOARD OF BEHAVIORAL SCIENCES