Healthcare Provider Details

I. General information

NPI: 1902408941
Provider Name (Legal Business Name): JENNIE MEROVICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

924 MENDOCINO AVE
BERKELEY CA
94707-1925
US

IV. Provider business mailing address

PO BOX 7262
BERKELEY CA
94707-0262
US

V. Phone/Fax

Practice location:
  • Phone: 510-332-7834
  • Fax:
Mailing address:
  • Phone: 707-366-0272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: