Healthcare Provider Details

I. General information

NPI: 1457233306
Provider Name (Legal Business Name): JERLINA LOVE
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/22/2025
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 ATHOL AVE APT 4
OAKLAND CA
94606-1559
US

IV. Provider business mailing address

509 ATHOL AVE APT 4
OAKLAND CA
94606-1559
US

V. Phone/Fax

Practice location:
  • Phone: 415-484-3302
  • Fax:
Mailing address:
  • Phone: 510-393-6924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number35899
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: