Provider Demographics
NPI:1336287713
Name:PEERY, JEROLYN (MA, PSYCHOLOGY)
Entity Type:Individual
Prefix:
First Name:JEROLYN
Middle Name:
Last Name:PEERY
Suffix:
Gender:F
Credentials:MA, PSYCHOLOGY
Other - Prefix:
Other - First Name:JEROLYN
Other - Middle Name:PEERY
Other - Last Name:POLITZER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, PSYCHOLOGY
Mailing Address - Street 1:3301 E 12TH ST
Mailing Address - Street 2:259
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3424
Mailing Address - Country:US
Mailing Address - Phone:510-269-9102
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST
Practice Address - Street 2:259
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3424
Practice Address - Country:US
Practice Address - Phone:510-269-9102
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41384106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist