Provider Demographics
NPI:1528658606
Name:AZAM, JENNIFER DAWN PEARCE (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN PEARCE
Last Name:AZAM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6742 PINEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1014
Mailing Address - Country:US
Mailing Address - Phone:978-857-5104
Mailing Address - Fax:
Practice Address - Street 1:6742 PINEHAVEN RD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-1014
Practice Address - Country:US
Practice Address - Phone:978-857-5104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW965321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical