Provider Demographics
NPI:1366659047
Name:FARBER, JESSICA ELIZABETH (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:ELIZABETH
Last Name:FARBER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3880 S BASCOM AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95124-2674
Mailing Address - Country:US
Mailing Address - Phone:408-800-2836
Mailing Address - Fax:408-371-9193
Practice Address - Street 1:3880 S BASCOM AVE STE 111
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-2600
Practice Address - Country:US
Practice Address - Phone:408-800-2836
Practice Address - Fax:408-371-9193
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2019-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist