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NPI Code Detail

MEDICARE: JACQUELYN RODGERS GALBREATH MFT, PHD

MEDICARE:   JACQUELYN RODGERS GALBREATH  MFT, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor24432CA

General Provider Information

NPI Number : 1104381995
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELYN RODGERS GALBREATH MFT, PHD
Provider Business Mailing Address
First Line : 338 MULLINIX WAY
Second Line :
City : SAN JOSE
State : CA
Zip : 95136-3775
Country : US
Telephone Number : 831-459-2628
Fax Number :
Provider Business Practice Location Address
First Line : 1 WASHINGTON SQ
Second Line :
City : SAN JOSE
State : CA
Zip : 95192-1077
Country : US
Telephone Number : 408-294-5678
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2019
Last Update Date : 08/06/2025

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