Provider Demographics
NPI:1730466384
Name:BARDACKE, JAIME M (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:JAIME
Middle Name:M
Last Name:BARDACKE
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 1:605 CHENERY ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-3033
Mailing Address - Country:US
Mailing Address - Phone:415-484-5911
Mailing Address - Fax:
Practice Address - Street 1:605 CHENERY ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94131-3033
Practice Address - Country:US
Practice Address - Phone:415-484-5911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA270441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical