MEDICARE: JENNIFER WACHTER L.C.S.W.

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	1041C0700X	Clinical Social Worker	19234	CA

General Provider Information

NPI Number	:	1811101041
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER WACHTER L.C.S.W.

Provider Business Mailing Address
First Line	:	522 TALBOT AVE
Second Line	:
City	:	ALBANY
State	:	CA
Zip	:	94706-1306
Country	:	US
Telephone Number	:	510-501-9860
Fax Number	:

Provider Business Practice Location Address
First Line	:	2041 BANCROFT WAY
Second Line	:	SUITE 307
City	:	BERKELEY
State	:	CA
Zip	:	94704-1405
Country	:	US
Telephone Number	:	510-501-9860
Fax Number	:

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	07/29/2009

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