Provider Demographics
NPI:1811101041
Name:WACHTER, JENNIFER (LCSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:WACHTER
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 1:522 TALBOT AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1306
Mailing Address - Country:US
Mailing Address - Phone:510-501-9860
Mailing Address - Fax:
Practice Address - Street 1:2041 BANCROFT WAY
Practice Address - Street 2:SUITE 307
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1405
Practice Address - Country:US
Practice Address - Phone:510-501-9860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical