Provider Demographics
NPI:1699491506
Name:CORNELL, JENNIFER ELIZABETH (AMFT134874)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:ELIZABETH
Last Name:CORNELL
Suffix:
Gender:F
Credentials:AMFT134874
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4624 BROOKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-2588
Mailing Address - Country:US
Mailing Address - Phone:415-279-7137
Mailing Address - Fax:
Practice Address - Street 1:2354 POST ST STE B
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3424
Practice Address - Country:US
Practice Address - Phone:415-857-1925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-13
Last Update Date:2022-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT134874101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health