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NPI Code Detail

MEDICARE: JENNIFER NICOLE CALDWELL ASSOCIATE MFT

MEDICARE: JENNIFER NICOLE CALDWELL ASSOCIATE MFT
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 TherapistAMFT106444CA

General Provider Information

NPI Number : 1821566704
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER NICOLE CALDWELL ASSOCIATE MFT
Provider Business Mailing Address
First Line : 2624 73RD AVE APT A
Second Line :
City : OAKLAND
State : CA
Zip : 94605-2844
Country : US
Telephone Number : 510-560-1821
Fax Number :
Provider Business Practice Location Address
First Line : 1835 ALLSTON WAY
Second Line :
City : BERKELEY
State : CA
Zip : 94703-1764
Country : US
Telephone Number : 510-613-0330
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2018
Last Update Date : 12/13/2019

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