Provider Demographics
NPI:1013359355
Name:JELINSKI, LAURA (MFT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:JELINSKI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:RORY
Other - Middle Name:
Other - Last Name:JELINSKI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:450 40TH ST APT 305
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609
Mailing Address - Country:US
Mailing Address - Phone:510-292-5619
Mailing Address - Fax:
Practice Address - Street 1:444 34TH ST, SUITE 3
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609
Practice Address - Country:US
Practice Address - Phone:510-292-5619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 53636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist