Provider Demographics
NPI:1962953133
Name:KOSKO, JENNIE FARBER (MSW SOCIAL WORK INTE)
Entity type:Individual
Prefix:MS
First Name:JENNIE
Middle Name:FARBER
Last Name:KOSKO
Suffix:
Gender:F
Credentials:MSW SOCIAL WORK INTE
Other - Prefix:
Other - First Name:JENNIE
Other - Middle Name:LEE
Other - Last Name:FARBER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5504 DARTMOUTH DR.
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95118
Mailing Address - Country:US
Mailing Address - Phone:650-399-6369
Mailing Address - Fax:
Practice Address - Street 1:1340 TULLY ROAD
Practice Address - Street 2:SUITE 304
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122
Practice Address - Country:US
Practice Address - Phone:408-271-3900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CARA858809101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARA858809OtherCCAPP