Healthcare Provider Details

I. General information

NPI: 1437887312
Provider Name (Legal Business Name): JENNIFER LYNN MAAMO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/09/2022
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1852 W 11TH ST STE 246
TRACY CA
95376-3736
US

IV. Provider business mailing address

1852 W 11TH ST STE 246
TRACY CA
95376-3736
US

V. Phone/Fax

Practice location:
  • Phone: 209-203-0927
  • Fax:
Mailing address:
  • Phone: 209-203-0927
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLPCC22943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: