Provider Demographics
NPI:1689868432
Name:JURKIEWICZ, MICHELLE (PSYD, MFT)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:
Last Name:JURKIEWICZ
Suffix:
Gender:F
Credentials:PSYD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 SHATTUCK AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1567
Mailing Address - Country:US
Mailing Address - Phone:510-334-7023
Mailing Address - Fax:
Practice Address - Street 1:2397 SHATTUCK AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1567
Practice Address - Country:US
Practice Address - Phone:510-334-7023
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44237106H00000X
CA29048103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist