Provider Demographics
NPI:1699085407
Name:NEGRETE, JACQUE MICHAEL (LCSW)
Entity type:Individual
Prefix:MR
First Name:JACQUE
Middle Name:MICHAEL
Last Name:NEGRETE
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:PO BOX 1259
Mailing Address - Street 2:
Mailing Address - City:SELMA
Mailing Address - State:CA
Mailing Address - Zip Code:93662-1259
Mailing Address - Country:US
Mailing Address - Phone:775-450-1596
Mailing Address - Fax:
Practice Address - Street 1:8881 FLETCHER PKWY STE 350-360
Practice Address - Street 2:
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-3134
Practice Address - Country:US
Practice Address - Phone:858-279-1223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV2632-C1041C0700X
CALCSW823461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical