1659472660 NPI number — MS. JACQUELYN AMY SCHWARTZ MA, LMFT

Table of content: MS. JACQUELYN AMY SCHWARTZ MA, LMFT (NPI 1659472660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659472660 NPI number — MS. JACQUELYN AMY SCHWARTZ MA, LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCHWARTZ
Provider First Name:
JACQUELYN
Provider Middle Name:
AMY
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA, LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1659472660
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4676 SERENATA PLACE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-735-9807
Provider Business Mailing Address Fax Number:
858-793-9807

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11772 SORRENTO VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 157
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1015
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-356-5839
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2006

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:  MFC 49159 , 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)





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