MEDICARE: MS. JENNIFER F HALLER 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	LCS13055	CA

General Provider Information

NPI Number	:	1679500227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JENNIFER F HALLER LCSW

Provider Business Mailing Address
First Line	:	11100 SAN PABLO AVE
Second Line	:	SUITE 202
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2194
Country	:	US
Telephone Number	:	510-232-3751
Fax Number	:	510-524-0359

Provider Business Practice Location Address
First Line	:	11100 SAN PABLO AVE
Second Line	:	SUITE 202
City	:	EL CERRITO
State	:	CA
Zip	:	94530-2194
Country	:	US
Telephone Number	:	510-232-3751
Fax Number	:	510-524-0359

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	07/08/2007

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