Provider Demographics
NPI:1770816209
Name:SENDAYDIEGO, JERWYN CARRIGER (MA, PPS, MFTI)
Entity Type:Individual
Prefix:MR
First Name:JERWYN
Middle Name:CARRIGER
Last Name:SENDAYDIEGO
Suffix:
Gender:M
Credentials:MA, PPS, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 EMPIRE ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-5702
Mailing Address - Country:US
Mailing Address - Phone:707-425-5744
Mailing Address - Fax:
Practice Address - Street 1:801 EMPIRE ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-5702
Practice Address - Country:US
Practice Address - Phone:707-400-3790
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 60710106H00000X
CA88338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA101YM0800XOtherCOUNSELOR, MENTAL HEALTH