Provider Demographics
NPI:1730606161
Name:BOOTH, JENNIFER ASHLEY TOMER (LCSW)
Entity type:Individual
Prefix:MS
First Name:JENNIFER ASHLEY
Middle Name:TOMER
Last Name:BOOTH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19141 GOLDEN VALLEY RD # 1080
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91387-1428
Mailing Address - Country:US
Mailing Address - Phone:831-515-8937
Mailing Address - Fax:
Practice Address - Street 1:333 S BEAUDRY AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1466
Practice Address - Country:US
Practice Address - Phone:831-213-2413
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-25
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1198831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical