Provider Demographics
NPI:1588726228
Name:VAVAROUTSOS, JAMIE C (LCSW)
Entity type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:C
Last Name:VAVAROUTSOS
Suffix:
Gender:F
Credentials:LCSW
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Mailing Address - Street 1:2980 E CAPITOL EXPY
Mailing Address - Street 2:#50-280
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-4246
Mailing Address - Country:US
Mailing Address - Phone:408-799-3972
Mailing Address - Fax:408-531-9684
Practice Address - Street 1:701 WELCH RD
Practice Address - Street 2:STE. #320
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94304-1709
Practice Address - Country:US
Practice Address - Phone:408-799-3972
Practice Address - Fax:408-531-9684
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA173141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical