Healthcare Provider Details

I. General information

NPI: 1255989083
Provider Name (Legal Business Name): JULIANNE JACOBS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 09/29/2025
Certification Date: 09/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1727 MARTIN LUTHER KING JR WAY STE 105
OAKLAND CA
94612-1358
US

IV. Provider business mailing address

1727 MARTIN LUTHER KING JR WAY STE 105
OAKLAND CA
94612-1358
US

V. Phone/Fax

Practice location:
  • Phone: 510-214-3013
  • Fax:
Mailing address:
  • Phone: 510-214-3013
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105330
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number124835
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: