Provider Demographics
NPI:1225572175
Name:NEUFELD, JERRY WILLIAM JR (RADT II)
Entity Type:Individual
Prefix:MR
First Name:JERRY
Middle Name:WILLIAM
Last Name:NEUFELD
Suffix:JR
Gender:M
Credentials:RADT II
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:3533 MOUNT VERNON AVE
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93306-1545
Mailing Address - Country:US
Mailing Address - Phone:661-871-3353
Mailing Address - Fax:661-871-9549
Practice Address - Street 1:3533 MOUNT VERNON AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93306-1545
Practice Address - Country:US
Practice Address - Phone:661-871-3353
Practice Address - Fax:661-871-9549
Is Sole Proprietor?:No
Enumeration Date:2016-12-12
Last Update Date:2017-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARII06010217101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA95-3111169OtherMEDICAL