Provider Demographics
NPI:1194998047
Name:LADRECH, JACQUELINE MAY (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MAY
Last Name:LADRECH
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 TAMAL VISTA BLVD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:CORTE MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:94925-1132
Mailing Address - Country:US
Mailing Address - Phone:415-479-9008
Mailing Address - Fax:415-499-0631
Practice Address - Street 1:240 TAMAL VISTA BLVD
Practice Address - Street 2:SUITE 270
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1132
Practice Address - Country:US
Practice Address - Phone:415-479-9008
Practice Address - Fax:415-499-0631
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-10
Last Update Date:2008-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC20178101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health