Provider Demographics
NPI:1528198231
Name:TRACHTENBERG, JAMIE (LCSW, ACHP-SW)
Entity Type:Individual
Prefix:MS
First Name:JAMIE
Middle Name:
Last Name:TRACHTENBERG
Suffix:
Gender:F
Credentials:LCSW, ACHP-SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:471 E TAHQUITZ CANYON WAY STE 222
Mailing Address - Street 2:
Mailing Address - City:PALM SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:92262-6620
Mailing Address - Country:US
Mailing Address - Phone:917-696-0060
Mailing Address - Fax:
Practice Address - Street 1:471 E TAHQUITZ CANYON WAY
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-6620
Practice Address - Country:US
Practice Address - Phone:917-696-0060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY083924-11041C0700X
CALCSW869421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical