Healthcare Provider Details

I. General information

NPI: 1821951831
Provider Name (Legal Business Name): BEVERLY ANN JARVIS LCSW23094
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2025
Last Update Date: 12/05/2025
Certification Date: 12/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3412 PUTTER DR
SOQUEL CA
95073-2763
US

IV. Provider business mailing address

3412 PUTTER DR
SOQUEL CA
95073-2763
US

V. Phone/Fax

Practice location:
  • Phone: 831-359-7503
  • Fax:
Mailing address:
  • Phone: 831-359-7503
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number23094
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: