Provider Demographics
NPI:1487283115
Name:WARREN, JACLYN (LMFT)
Entity type:Individual
Prefix:
First Name:JACLYN
Middle Name:
Last Name:WARREN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3316 MARCEL CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95135-1158
Mailing Address - Country:US
Mailing Address - Phone:408-781-9284
Mailing Address - Fax:408-274-5532
Practice Address - Street 1:3316 MARCEL CT
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95135-1158
Practice Address - Country:US
Practice Address - Phone:408-781-9284
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-04
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA138795106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty