Provider Demographics
NPI:1689890345
Name:PEARSON, JAQUELIN N (MFT)
Entity Type:Individual
Prefix:MS
First Name:JAQUELIN
Middle Name:N
Last Name:PEARSON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 OAKCREST DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-2842
Mailing Address - Country:US
Mailing Address - Phone:415-479-5632
Mailing Address - Fax:415-479-5861
Practice Address - Street 1:13 OAKCREST DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-2842
Practice Address - Country:US
Practice Address - Phone:415-479-5632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC33314174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist