Provider Demographics
NPI:1659472660
Name:SCHWARTZ, JACQUELYN AMY (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:AMY
Last Name:SCHWARTZ
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4676 SERENATA PLACE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130
Mailing Address - Country:US
Mailing Address - Phone:858-735-9807
Mailing Address - Fax:858-793-9807
Practice Address - Street 1:11772 SORRENTO VALLEY RD
Practice Address - Street 2:SUITE 157
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1015
Practice Address - Country:US
Practice Address - Phone:858-356-5839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2011-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 49159106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist