Provider Demographics
NPI:1275152324
Name:JESTER, NICHOLAS MICHAEL
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:MICHAEL
Last Name:JESTER
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 1:1820 SCENIC AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1324
Mailing Address - Country:US
Mailing Address - Phone:105-487-2705
Mailing Address - Fax:
Practice Address - Street 1:1610 MILVIA ST APT 2
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2047
Practice Address - Country:US
Practice Address - Phone:510-362-4378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-09
Last Update Date:2020-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)