Provider Demographics
NPI:1669460523
Name:TAYLOR, JEAN B (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEAN
Middle Name:B
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 DONDEE ST
Mailing Address - Street 2:SUITE #9
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3056
Mailing Address - Country:US
Mailing Address - Phone:650-738-9550
Mailing Address - Fax:650-738-9567
Practice Address - Street 1:450 DONDEE ST
Practice Address - Street 2:SUITE #9
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-3056
Practice Address - Country:US
Practice Address - Phone:650-738-9550
Practice Address - Fax:650-738-9567
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 0064251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical