Provider Demographics
NPI:1346970373
Name:JENNY VLADIMIROV
Entity Type:Organization
Organization Name:JENNY VLADIMIROV
Other - Org Name:JENNY VLADIMIROV
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:EVGENIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:VLADIMIROV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:415-729-5886
Mailing Address - Street 1:2142 ROOSEVELT AVE
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-5606
Mailing Address - Country:US
Mailing Address - Phone:650-391-3085
Mailing Address - Fax:
Practice Address - Street 1:2142 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-5606
Practice Address - Country:US
Practice Address - Phone:650-391-3085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-13
Last Update Date:2022-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty