Healthcare Provider Details

I. General information

NPI: 1336919752
Provider Name (Legal Business Name): JAMIE PENTICOFF GONZALEZ ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. JAMIE MARGARET PENTICOFF

II. Dates (important events)

Enumeration Date: 01/05/2024
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 267
OAKLAND CA
94605-2408
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 267
OAKLAND CA
94605-2408
US

V. Phone/Fax

Practice location:
  • Phone: 510-923-1099
  • Fax: 510-923-1099
Mailing address:
  • Phone: 510-923-1099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: