Provider Demographics
NPI:1679955108
Name:CASTANEDA, JENNIFER (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:
Last Name:CASTANEDA
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:ROMERO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:510 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1992
Mailing Address - Country:US
Mailing Address - Phone:213-760-6553
Mailing Address - Fax:
Practice Address - Street 1:10515 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-6355
Practice Address - Country:US
Practice Address - Phone:213-760-6553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-20
Last Update Date:2022-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CA1034171041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical