Healthcare Provider Details

I. General information

NPI: 1538376140
Provider Name (Legal Business Name): JAMIE WATKINS L.C.S.W
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST CVC SEED
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

235 BERRY ST APT. 503
SAN FRANCISCO CA
94158-1629
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3160
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number26252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: