Provider Demographics
NPI:1144496043
Name:GENDRON, JESSE P (LMSW)
Entity type:Individual
Prefix:MR
First Name:JESSE
Middle Name:P
Last Name:GENDRON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:443 CHAPLAIN MAGSIG AVE BLDG 830
Mailing Address - Street 2:
Mailing Address - City:PRESIDIO OF MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93944-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:443 CHAPLAIN MAGSIG AVE BLDG 830
Practice Address - Street 2:
Practice Address - City:PRESIDIO OF MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93944-3100
Practice Address - Country:US
Practice Address - Phone:831-242-4117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-01
Last Update Date:2025-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010967731041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker