Basic Information
| Provider Information | |||||||||
| NPI: | 1043404056 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BARNETT | ||||||||
| FirstName: | JACQUELINE | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3300 IRVINE AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926603109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493579074 | ||||||||
| FaxNumber: | 9492509485 | ||||||||
| Practice Location | |||||||||
| Address1: | 3300 IRVINE AVE | ||||||||
| Address2: | SUITE 111 | ||||||||
| City: | NEWPORT BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926603109 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9493579074 | ||||||||
| FaxNumber: | 9492509485 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/02/2007 | ||||||||
| LastUpdateDate: | 07/03/2013 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | LCS 21184 | CA | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.