Provider Demographics
NPI:1477745065
Name:MCCAULEY-DOBLACK, JENNIFER CHRISTINE (LMFT, LPCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CHRISTINE
Last Name:MCCAULEY-DOBLACK
Suffix:
Gender:F
Credentials:LMFT, LPCC
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 3361
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95055-3361
Mailing Address - Country:US
Mailing Address - Phone:408-309-8672
Mailing Address - Fax:
Practice Address - Street 1:2166 THE ALAMEDA
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-1144
Practice Address - Country:US
Practice Address - Phone:408-640-5039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51877106H00000X
CA687101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional