Provider Demographics
NPI:1346378817
Name:SAJJADI, MINERVA (LC SOCIAL WORKER)
Entity type:Individual
Prefix:
First Name:MINERVA
Middle Name:
Last Name:SAJJADI
Suffix:
Gender:F
Credentials:LC SOCIAL WORKER
Other - Prefix:MRS
Other - First Name:MINERVA
Other - Middle Name:
Other - Last Name:SAJJADI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:290 N 10TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-3052
Mailing Address - Country:US
Mailing Address - Phone:909-825-6188
Mailing Address - Fax:909-872-0652
Practice Address - Street 1:290 N 10TH ST STE 102
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3052
Practice Address - Country:US
Practice Address - Phone:909-825-6188
Practice Address - Fax:909-872-0652
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS258941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical