Provider Demographics
NPI:1447567417
Name:PERSONS, JACQUELINE BUNKER
Entity Type:Individual
Prefix:DR
First Name:JACQUELINE
Middle Name:BUNKER
Last Name:PERSONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 COLLEGE AVE
Mailing Address - Street 2:SUITE 215
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1599
Mailing Address - Country:US
Mailing Address - Phone:510-992-4040
Mailing Address - Fax:888-975-9811
Practice Address - Street 1:5435 COLLEGE AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1598
Practice Address - Country:US
Practice Address - Phone:510-652-4455
Practice Address - Fax:510-380-2988
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-10
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7275103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral