Basic Information
| Provider Information | |||||||||
| NPI: | 1861844938 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DE LEON | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | Y | ||||||||
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| Mailing Information | |||||||||
| Address1: | 333 S BEAUDRY AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132413841 | ||||||||
| FaxNumber: | 2132413305 | ||||||||
| Practice Location | |||||||||
| Address1: | 333 S BEAUDRY AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900171466 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2132413841 | ||||||||
| FaxNumber: | 2132413305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2016 | ||||||||
| LastUpdateDate: | 05/16/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW71725 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | LCSW107858 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.