Provider Demographics
NPI:1164657722
Name:BORRELLI, JENNA MARIE (ASW)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:BORRELLI
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:TRAINOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW INTERN
Mailing Address - Street 1:22245 MAIN ST.
Mailing Address - Street 2:SUITE 200
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541
Mailing Address - Country:US
Mailing Address - Phone:650-494-1200
Mailing Address - Fax:650-494-1243
Practice Address - Street 1:22245 MAIN ST.
Practice Address - Street 2:SUITE 200
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541
Practice Address - Country:US
Practice Address - Phone:650-494-1200
Practice Address - Fax:650-494-1243
Is Sole Proprietor?:No
Enumeration Date:2009-05-26
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA291451041S0200X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool