Healthcare Provider Details

I. General information

NPI: 1649502642
Provider Name (Legal Business Name): JESSICA JILL BRUGEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 SHATTUCK AVE
BERKELEY CA
94709-1700
US

IV. Provider business mailing address

5956 LAIRD AVE
OAKLAND CA
94605-1726
US

V. Phone/Fax

Practice location:
  • Phone: 510-282-4146
  • Fax:
Mailing address:
  • Phone: 510-282-4146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS25590
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 25590
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: