Healthcare Provider Details

I. General information

NPI: 1437818531
Provider Name (Legal Business Name): JENNIFER M OTIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 TEMPLE DR
PACHECO CA
94553-5112
US

IV. Provider business mailing address

1144 TEMPLE DR
PACHECO CA
94553-5112
US

V. Phone/Fax

Practice location:
  • Phone: 925-324-1488
  • Fax:
Mailing address:
  • Phone: 925-324-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number142023
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: