=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851009757
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNIFER LEA GRIFFITH-TWOMEY
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2022
-----------------------------------------------------
Last Update Date | 12/30/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 SEENO ST
-----------------------------------------------------
City | PITTSBURG
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94565-5855
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-821-1838
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26385 ADRIAN AVE
-----------------------------------------------------
City | HAYWARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94545-3005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-364-7754
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------