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NPI Code Detail

MEDICARE: CAROLYN MARIE JASCULCA M.A, M.P.A, MFTI

MEDICARE: CAROLYN MARIE JASCULCA M.A, M.P.A, MFTI
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 Therapist94257CA

General Provider Information

NPI Number : 1164934253
Entity Type Code : Individual
Provider Name (Legal Business Name) : CAROLYN MARIE JASCULCA M.A, M.P.A, MFTI
Provider Business Mailing Address
First Line : 626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-3725
Country : US
Telephone Number : 415-840-5214
Fax Number :
Provider Business Practice Location Address
First Line : 626 BALBOA ST
Second Line :
City : SAN FRANCISCO
State : CA
Zip : 94118-3725
Country : US
Telephone Number : 415-840-5214
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/29/2017
Last Update Date : 10/29/2017

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