Provider Demographics
NPI:1477717783
Name:JANDRISEVITS, EILEEN M (MS, MFT, CADC-I)
Entity Type:Individual
Prefix:
First Name:EILEEN
Middle Name:M
Last Name:JANDRISEVITS
Suffix:
Gender:F
Credentials:MS, MFT, CADC-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-0030
Mailing Address - Country:US
Mailing Address - Phone:925-484-3450
Mailing Address - Fax:
Practice Address - Street 1:6200 STONERIDGE MALL RD
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-3242
Practice Address - Country:US
Practice Address - Phone:925-484-3450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA08451504101YA0400X
CAMFT17882101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)