Provider Demographics
NPI:1265628770
Name:KERECMAN, JEN ALAINE (MSW)
Entity Type:Individual
Prefix:
First Name:JEN
Middle Name:ALAINE
Last Name:KERECMAN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 SHADOW ROCK DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8446
Mailing Address - Country:US
Mailing Address - Phone:916-398-0454
Mailing Address - Fax:
Practice Address - Street 1:950 SHADOW ROCK DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8446
Practice Address - Country:US
Practice Address - Phone:916-398-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health