Provider Demographics
NPI:1477587046
Name:DAHLSTROM, JENIFER E (MFT, CEAP, SAP)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:E
Last Name:DAHLSTROM
Suffix:
Gender:F
Credentials:MFT, CEAP, SAP
Other - Prefix:
Other - First Name:JENIFER
Other - Middle Name:E
Other - Last Name:BAMBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:492 CLIFTON STREET
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618
Mailing Address - Country:US
Mailing Address - Phone:510-273-9261
Mailing Address - Fax:510-653-8787
Practice Address - Street 1:492 CLIFTON ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1162
Practice Address - Country:US
Practice Address - Phone:510-273-9261
Practice Address - Fax:510-653-8787
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA30247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health