Provider Demographics
NPI:1366278939
Name:JOSE, ANNIE ELIZABETH
Entity type:Individual
Prefix:
First Name:ANNIE
Middle Name:ELIZABETH
Last Name:JOSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7266 CLEAR VISTA CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95138-1393
Mailing Address - Country:US
Mailing Address - Phone:209-582-3624
Mailing Address - Fax:
Practice Address - Street 1:248 REDWOOD AVE
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94061-3074
Practice Address - Country:US
Practice Address - Phone:650-839-1076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor