Provider Demographics
NPI:1124645213
Name:JONES-WIERTZ, LISA MARIE (ASW, CATC-III)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:MARIE
Last Name:JONES-WIERTZ
Suffix:
Gender:F
Credentials:ASW, CATC-III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:265 S ANITA DR
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3355
Mailing Address - Country:US
Mailing Address - Phone:951-665-4160
Mailing Address - Fax:
Practice Address - Street 1:265 S ANITA DR
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3355
Practice Address - Country:US
Practice Address - Phone:949-749-2500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA124071104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker