Provider Demographics
NPI:1104645720
Name:GIVENS, JENNIFER ANDREA
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:ANDREA
Last Name:GIVENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12987 MORENO BEACH DR APT 14305
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4443
Mailing Address - Country:US
Mailing Address - Phone:562-754-3659
Mailing Address - Fax:
Practice Address - Street 1:3281 E GUASTI RD STE 440
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7635
Practice Address - Country:US
Practice Address - Phone:909-705-6354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-09
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical