Provider Demographics
NPI:1417159732
Name:RICHARD, JACQUELINE JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:JANE
Last Name:RICHARD
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 1:533 E. MICHELTORENA STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2274
Mailing Address - Country:US
Mailing Address - Phone:805-564-8200
Mailing Address - Fax:805-564-4908
Practice Address - Street 1:601 E ARRELLAGA ST
Practice Address - Street 2:SUITE 201
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2274
Practice Address - Country:US
Practice Address - Phone:805-564-8200
Practice Address - Fax:805-564-4908
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33114106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist