1902966005 NPI number — MS. JACQUELINE KAY SORENSON-MCDANIEL M.A., LMFT

Table of content: MS. JACQUELINE KAY SORENSON-MCDANIEL M.A., LMFT (NPI 1902966005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902966005 NPI number — MS. JACQUELINE KAY SORENSON-MCDANIEL M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORENSON-MCDANIEL
Provider First Name:
JACQUELINE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SORENSON-MCDANIEL, MFT
Provider Other First Name:
JACQUELINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.A., LMFT
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1902966005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2909 LOOMIS STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90712-3318
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
562-422-2240
Provider Business Mailing Address Fax Number:
562-423-1816

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4525 E ATHERTON ST
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
LONG BEACH
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90815-3700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-422-2240
Provider Business Practice Location Address Fax Number:
562-423-1816
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC32999 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com