Healthcare Provider Details

I. General information

NPI: 1154938686
Provider Name (Legal Business Name): JENNIFER E GOLDBERG ALLEN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2020
Last Update Date: 04/25/2025
Certification Date: 04/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 S K ST
TULARE CA
93274-5416
US

IV. Provider business mailing address

327 S K ST
TULARE CA
93274-5416
US

V. Phone/Fax

Practice location:
  • Phone: 559-688-2043
  • Fax: 559-688-1304
Mailing address:
  • Phone: 559-688-2043
  • Fax: 559-688-1304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number129173
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: