Provider Demographics
NPI:1679608962
Name:KADESH, JEANETTE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:
Last Name:KADESH
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 1:1214 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901
Mailing Address - Country:US
Mailing Address - Phone:415-721-1720
Mailing Address - Fax:415-472-3829
Practice Address - Street 1:1214 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3230
Practice Address - Country:US
Practice Address - Phone:415-721-1720
Practice Address - Fax:415-472-3829
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS15739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS157390OtherBLUE SHIELD
CA6201349OtherUBH
CAMHN231723OtherGEHA CA
R20633Medicare UPIN
CAMMM00072MMedicare ID - Type Unspecified