Provider Demographics
NPI:1841065935
Name:JORGENSEN, MONICA RAE (ACSW, BCBA)
Entity type:Individual
Prefix:DR
First Name:MONICA
Middle Name:RAE
Last Name:JORGENSEN
Suffix:
Gender:F
Credentials:ACSW, BCBA
Other - Prefix:
Other - First Name:MONICA
Other - Middle Name:RAE
Other - Last Name:RUTH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8301 JUNE LAKE DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3101
Mailing Address - Country:US
Mailing Address - Phone:619-929-9492
Mailing Address - Fax:
Practice Address - Street 1:8301 JUNE LAKE DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3101
Practice Address - Country:US
Practice Address - Phone:619-929-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-17
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1192021041C0700X
CA1-20-41753103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical