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NPI Code Detail

MEDICARE: JESSE KOVALCIK LMFT

MEDICARE: JESSE KOVALCIK LMFT
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
1106H00000XMarriage & Family Therapist
2106H00000XMarriage & Family Therapist83782CA

General Provider Information

NPI Number : 1134409733
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSE KOVALCIK LMFT
Provider Business Mailing Address
First Line : 150 LINDEN ST
Second Line :
City : OAKLAND
State : CA
Zip : 94607-2538
Country : US
Telephone Number : 510-273-4700
Fax Number :
Provider Business Practice Location Address
First Line : 150 LINDEN ST
Second Line :
City : OAKLAND
State : CA
Zip : 94607-2538
Country : US
Telephone Number : 510-273-4700
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/26/2011
Last Update Date : 04/28/2025

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Directions to “ JESSE KOVALCIK LMFT” Practice Location

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