1336287713 NPI number — JEROLYN PEERY MA, PSYCHOLOGY

Table of content: JEROLYN PEERY MA, PSYCHOLOGY (NPI 1336287713)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336287713 NPI number — JEROLYN PEERY MA, PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEERY
Provider First Name:
JEROLYN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, PSYCHOLOGY
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
POLITZER
Provider Other First Name:
JEROLYN
Provider Other Middle Name:
PEERY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, PSYCHOLOGY
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1336287713
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3301 E 12TH ST
Provider Second Line Business Mailing Address:
259
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94601-3424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-269-9102
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3301 E 12TH ST
Provider Second Line Business Practice Location Address:
259
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94601-3424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-269-9102
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/01/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC41384 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)