Basic Information
Provider Information
NPI: 1831255660
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JANSSEN
FirstName: ALMA
MiddleName: DELIA
NamePrefix:  
NameSuffix:  
Credential: MSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1704 MISSION AVE
Address2:  
City: CARMICHAEL
State: CA
PostalCode: 956085617
CountryCode: US
TelephoneNumber: 9163590888
FaxNumber:  
Practice Location
Address1: 2750 SUTTERVILLE RD
Address2:  
City: SACRAMENTO
State: CA
PostalCode: 958201024
CountryCode: US
TelephoneNumber: 9164523981
FaxNumber: 9164545031
Other Information
ProviderEnumerationDate: 12/28/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700XASW 20667CAY Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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