Provider Demographics
NPI:1194973594
Name:JOE, JEANINE THERESE
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:THERESE
Last Name:JOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:THERESE
Other - Last Name:BAJEK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2500 BISSELL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94804-1815
Mailing Address - Country:US
Mailing Address - Phone:707-330-2251
Mailing Address - Fax:
Practice Address - Street 1:2500 BISSELL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1815
Practice Address - Country:US
Practice Address - Phone:510-235-1516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-28
Last Update Date:2009-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health