Healthcare Provider Details

I. General information

NPI: 1669460523
Provider Name (Legal Business Name): JEAN B TAYLOR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 DONDEE ST SUITE #9
PACIFICA CA
94044-3056
US

IV. Provider business mailing address

450 DONDEE ST SUITE #9
PACIFICA CA
94044-3056
US

V. Phone/Fax

Practice location:
  • Phone: 650-738-9550
  • Fax: 650-738-9567
Mailing address:
  • Phone: 650-738-9550
  • Fax: 650-738-9567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 006425
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: