Provider Demographics
NPI:1427664440
Name:ADOLFO, JACQUELINE MIRANDA (AMFT)
Entity type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:MIRANDA
Last Name:ADOLFO
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:JACKIE
Other - Middle Name:
Other - Last Name:ADOLFO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2257 RIVER PLAZA DR APT 392
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95833-3854
Mailing Address - Country:US
Mailing Address - Phone:916-562-6813
Mailing Address - Fax:
Practice Address - Street 1:3050 BEACON BLVD STE 103
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3467
Practice Address - Country:US
Practice Address - Phone:916-462-3105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X, 390200000X
CA124381106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist