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

Table of content: MS. JESSICA LEIGH CARNESS MSW, LCSW (NPI 1356436281)

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)





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