Provider Demographics
NPI:1396807525
Name:RIESEN, JORIE LYNNE (MSW)
Entity type:Individual
Prefix:MRS
First Name:JORIE
Middle Name:LYNNE
Last Name:RIESEN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16580 COBALT CT
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-6132
Mailing Address - Country:US
Mailing Address - Phone:909-628-1272
Mailing Address - Fax:909-627-1906
Practice Address - Street 1:3683 CHINO AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4719
Practice Address - Country:US
Practice Address - Phone:909-628-1272
Practice Address - Fax:909-627-1906
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW#15798104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker