Provider Demographics
NPI:1225292287
Name:GEFFNER, JEROME YALE
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:YALE
Last Name:GEFFNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7141 PINEHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-1214
Mailing Address - Country:US
Mailing Address - Phone:510-653-3137
Mailing Address - Fax:
Practice Address - Street 1:235 W MACARTHUR BLVD
Practice Address - Street 2:MB BLDG. STE 640
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5641
Practice Address - Country:US
Practice Address - Phone:510-752-1340
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS126551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical