Provider Demographics
NPI:1689921322
Name:CANFIELD, JASMIN (CADC-CAS, LCSW)
Entity Type:Individual
Prefix:
First Name:JASMIN
Middle Name:
Last Name:CANFIELD
Suffix:
Gender:F
Credentials:CADC-CAS, LCSW
Other - Prefix:
Other - First Name:JASMIN
Other - Middle Name:
Other - Last Name:SHANCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10850 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-5266
Mailing Address - Country:US
Mailing Address - Phone:510-875-2300
Mailing Address - Fax:510-875-2310
Practice Address - Street 1:1411 E 31ST ST # B-2
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-1018
Practice Address - Country:US
Practice Address - Phone:510-437-4508
Practice Address - Fax:510-535-7478
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC057730618101YA0400X
104100000X
CA92973104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)