Provider Demographics
NPI:1427727908
Name:BASULTO, JENNIFER KARINA (MSW, ASW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:KARINA
Last Name:BASULTO
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1041 GILWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-2122
Mailing Address - Country:US
Mailing Address - Phone:626-465-6920
Mailing Address - Fax:
Practice Address - Street 1:14535 WHITTIER BLVD
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90605-2130
Practice Address - Country:US
Practice Address - Phone:562-907-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2025-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1088251041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool