Provider Demographics
NPI:1033383245
Name:BIRNBACH, JENNIFER MARY (MA)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARY
Last Name:BIRNBACH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:JENNY
Other - Middle Name:
Other - Last Name:BIRNBACH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:225 OTIS ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3551
Mailing Address - Country:US
Mailing Address - Phone:831-459-7980
Mailing Address - Fax:
Practice Address - Street 1:225 OTIS ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3551
Practice Address - Country:US
Practice Address - Phone:831-459-7980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-17
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 24288106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist