Provider Demographics
NPI:1629421912
Name:TRINKLE, JENNIFER CASEY
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CASEY
Last Name:TRINKLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LEIGH
Other - Last Name:CASEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1905 BERKELEY WAY STE 1
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1007
Mailing Address - Country:US
Mailing Address - Phone:510-344-2665
Mailing Address - Fax:
Practice Address - Street 1:1905 BERKELEY WAY STE 1
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1007
Practice Address - Country:US
Practice Address - Phone:510-344-2665
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-21
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA115546106H00000X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist