MEDICARE: MR. JACOB WILDING AVERY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	27985	CA

General Provider Information

NPI Number	:	1558639989
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JACOB WILDING AVERY LCSW

Provider Business Mailing Address
First Line	:	4258 HAWK ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1357
Country	:	US
Telephone Number	:	619-727-7167
Fax Number	:

Provider Business Practice Location Address
First Line	:	4258 HAWK ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1357
Country	:	US
Telephone Number	:	619-727-7167
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2011
Last Update Date	:	12/13/2011

Similar Medicare Providers

1881914000 — GRUPO MEDICO POLICLINICA SAN PEDRO MEDICARE ADVANTAGE
Practice Location Address:

211 CALLE MORSE
ARROYO, PR
00714-2350

Practice Phone: 787-839-3980
Practice Fax: 787-271-2515

1396291043 — MR. MICHAEL JAMES SENSENBAUGH DPT
Practice Location Address:

11439 SPICA DR
SAN DIEGO, CA
92126-1357

Practice Phone: 858-437-7569
Practice Fax:

1508708389 — KIMBERLIN BORCA LEON, LICENSED CLINICAL SOCIAL WORKER, INC.
Practice Location Address:

1357 HOPKINS DR
SAN JOSE, CA
95122-1627

Practice Phone: 916-246-6290
Practice Fax:

1477496180 — JACQUELINE COUSINEAU
Practice Location Address:

1357 SAN BRUNO AVE
SAN FRANCISCO, CA
94110-3527

Practice Phone: 408-444-0054
Practice Fax:

1700873957 — ST. ANNE'S HOME
Practice Location Address:

300 LAKE ST
SAN FRANCISCO, CA
94118-1357

Practice Phone: 415-751-6510
Practice Fax: 415-751-1423

1013992379 — DR. BELISARIO MATTA DE JUAN SR. M.D.
Practice Location Address:

ASHFORD AVENUE 1357 , SUITE 2 PMB 423
SAN JUAN, PR
00907-1420

Practice Phone: 787-725-7860
Practice Fax: 787-722-3630

Directions to “ MR. JACOB WILDING AVERY LCSW” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.