Provider Demographics
NPI:1558583567
Name:MINKOFF, JADILLE RIVA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JADILLE
Middle Name:RIVA
Last Name:MINKOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:JADILLE
Other - Middle Name:MINKOFF
Other - Last Name:MEAGHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P. O. BOX 1741
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-1741
Mailing Address - Country:US
Mailing Address - Phone:831-688-0144
Mailing Address - Fax:
Practice Address - Street 1:6233 SOQUEL DR STE C
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-3184
Practice Address - Country:US
Practice Address - Phone:831-588-3792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2016-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 098821041C0700X
CAPPSE1041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool