Healthcare Provider Details

I. General information

NPI: 1881095263
Provider Name (Legal Business Name): JENNIFER ESCOBAR ASW 102850
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2014
Last Update Date: 09/21/2021
Certification Date: 09/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

390 40TH ST
OAKLAND CA
94609-2633
US

IV. Provider business mailing address

4020 CIVIC CENTER DR
SAN RAFAEL CA
94903-4173
US

V. Phone/Fax

Practice location:
  • Phone: 510-653-5040
  • Fax:
Mailing address:
  • Phone: 415-491-2525
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW102850
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: