Provider Demographics
NPI:1902966005
Name:SORENSON-MCDANIEL, JACQUELINE KAY (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KAY
Last Name:SORENSON-MCDANIEL
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:SORENSON-MCDANIEL, MFT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LMFT
Mailing Address - Street 1:2909 LOOMIS STREET
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90712-3318
Mailing Address - Country:US
Mailing Address - Phone:562-422-2240
Mailing Address - Fax:562-423-1816
Practice Address - Street 1:4525 E ATHERTON ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-3700
Practice Address - Country:US
Practice Address - Phone:562-422-2240
Practice Address - Fax:562-423-1816
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC32999106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist