Provider Demographics
NPI:1255487815
Name:MALABAG-EVANS, JENNIFER ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ANN
Last Name:MALABAG-EVANS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2255 MORELLO AVE STE 233
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1897
Mailing Address - Country:US
Mailing Address - Phone:925-490-0512
Mailing Address - Fax:925-954-6935
Practice Address - Street 1:2255 MORELLO AVE STE 233
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1897
Practice Address - Country:US
Practice Address - Phone:925-490-0512
Practice Address - Fax:925-954-6935
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30400103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical