Provider Demographics
NPI:1306421771
Name:CARDENAS, JASON GREGORY (LCSW)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:GREGORY
Last Name:CARDENAS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 HOWELL DR UNIT 28
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-3853
Mailing Address - Country:US
Mailing Address - Phone:909-561-4017
Mailing Address - Fax:
Practice Address - Street 1:5931 HOWELL DR UNIT 28
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3853
Practice Address - Country:US
Practice Address - Phone:909-561-4017
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-16
Last Update Date:2021-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW925001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical