1356436281 NPI number — MS. JESSICA LEIGH CARNESS MSW, LCSW

Table of content: (NPI 1669813911)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356436281 NPI number — MS. JESSICA LEIGH CARNESS MSW, LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARNESS
Provider First Name:
JESSICA
Provider Middle Name:
LEIGH
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MSW, LCSW
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:
1356436281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
VETERANS ADMINISTRATION SDVA
Provider Second Line Business Mailing Address:
3350 LA JOLLA VILLAGE DR,
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92161-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-552-8585
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
VETERANS ADMINISTRATION, SACC
Provider Second Line Business Practice Location Address:
16111 PLUMMER AVE, BLDG 10, ROOM B-A109
Provider Business Practice Location Address City Name:
SEPULVEDA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-891-7711
Provider Business Practice Location Address Fax Number:
818-895-5819
Provider Enumeration Date:
10/04/2006

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: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 24536 , 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 © 2007-2025 www.npivalidator.com