Provider Demographics
NPI:1033301643
Name:TELLIER, JEN E (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JEN
Middle Name:E
Last Name:TELLIER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 WESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5651
Mailing Address - Country:US
Mailing Address - Phone:510-469-4132
Mailing Address - Fax:510-769-1105
Practice Address - Street 1:668 WESTLINE DR
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-5651
Practice Address - Country:US
Practice Address - Phone:510-469-4132
Practice Address - Fax:510-769-1105
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16925103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist