| NPI | 1174385058 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOLENE JACQUART Member 510-230-1065 |
| Organization Subpart ? | No |
| Primary Taxonomy | 363LP0808X Nurse Practitioner, Psych/Mental Health |
| Additional Taxonomies | 103TB0200X Psychologist, Cognitive & Behavioral |
| Enumeration Date | 2024-01-26 |
| Last Update Date | 2024-01-26 |