| Jacob Donnelly, Licensed Clinical Social Worker, Inc. | |
|
2428 Dwight Way Ste 9 Berkeley CA 94704-2399 | |
| (510) 982-6836 | |
| Not Available |
| Full Name | Jacob Donnelly, Licensed Clinical Social Worker, Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 2428 Dwight Way Ste 9, Berkeley, California |
| Authorized Official Name and Position | Jacob Donnelly (OWNER) |
| Authorized Official Contact | 5109826836 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Jacob Donnelly, Licensed Clinical Social Worker, Inc. 2428 Dwight Way Ste 9 Berkeley CA 94704-2399 Ph: (510) 982-6836 | Jacob Donnelly, Licensed Clinical Social Worker, Inc. 2428 Dwight Way Ste 9 Berkeley CA 94704-2399 Ph: (510) 982-6836 |
| NPI Number | 1336849546 |
|---|---|
| Provider Enumeration Date | 03/07/2023 |
| Last Update Date | 03/07/2023 |
| Certification Date | 03/06/2023 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336849546 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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