Provider Demographics
NPI:1851467435
Name:ENGWER, JAMIE ANN III (MA, IMF)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:ANN
Last Name:ENGWER
Suffix:III
Gender:F
Credentials:MA, IMF
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:ANN
Other - Last Name:COPPERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, IMF
Mailing Address - Street 1:2423 CAMINO DEL RIO S STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3734
Mailing Address - Country:US
Mailing Address - Phone:858-405-5510
Mailing Address - Fax:858-405-5510
Practice Address - Street 1:2423 CAMINO DEL RIO SOUTH
Practice Address - Street 2:SUITE 103
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:858-405-5510
Practice Address - Fax:619-293-3746
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA47983106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health