MEDICARE: MS. JESSICA MARLENA DECKER

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
1	106H00000X	Marriage & Family Therapist	142900	CA

General Provider Information

NPI Number	:	1346549813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JESSICA MARLENA DECKER

Provider Business Mailing Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	510-848-1112
Fax Number	:	510-848-4445

Provider Business Practice Location Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	510-848-1112
Fax Number	:	510-848-4445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2011
Last Update Date	:	12/04/2023

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