Provider Demographics
NPI:1174406482
Name:JLSM LICENSE CLINICAL SOCIAL WORKER, INC.
Entity type:Organization
Organization Name:JLSM LICENSE CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JHOANA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SARABIA MALDONADO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:424-789-0936
Mailing Address - Street 1:10820 ALONDRA BLVD # 1092
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-1502
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16600 WOODRUFF AVE # 312
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4916
Practice Address - Country:US
Practice Address - Phone:909-235-6237
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-07-26
Last Update Date:2025-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty