Provider Demographics
NPI:1750573671
Name:JENRETTE, JENNIFER LAURA (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LAURA
Last Name:JENRETTE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LAURA
Other - Last Name:SEGAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:18302 IRVINE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-3435
Mailing Address - Country:US
Mailing Address - Phone:714-881-8641
Mailing Address - Fax:714-979-8135
Practice Address - Street 1:18302 IRVINE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-3435
Practice Address - Country:US
Practice Address - Phone:714-881-8641
Practice Address - Fax:714-979-8135
Is Sole Proprietor?:No
Enumeration Date:2007-08-14
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker