Provider Demographics
NPI:1417213976
Name:KLIPPENES, JACQUELINE ROSE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACQUELINE
Middle Name:ROSE
Last Name:KLIPPENES
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21168 REDWOOD RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:CASTRO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94546-5932
Mailing Address - Country:US
Mailing Address - Phone:510-886-3300
Mailing Address - Fax:
Practice Address - Street 1:21168 REDWOOD RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:CASTRO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94546-5932
Practice Address - Country:US
Practice Address - Phone:510-886-3300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38097101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health