Healthcare Provider Details

I. General information

NPI: 1477745065
Provider Name (Legal Business Name): JENNIFER CHRISTINE MCCAULEY-DOBLACK LMFT, LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 12/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2166 THE ALAMEDA
SAN JOSE CA
95126-1144
US

IV. Provider business mailing address

PO BOX 3361
SANTA CLARA CA
95055-3361
US

V. Phone/Fax

Practice location:
  • Phone: 408-640-5039
  • Fax:
Mailing address:
  • Phone: 408-309-8672
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number687
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 51877
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: