Provider Demographics
NPI:1790542900
Name:SAINT JEAN, IMANI (MSW, MAED)
Entity Type:Individual
Prefix:
First Name:IMANI
Middle Name:
Last Name:SAINT JEAN
Suffix:
Gender:F
Credentials:MSW, MAED
Other - Prefix:
Other - First Name:IMAN
Other - Middle Name:
Other - Last Name:SAINT JEAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:457 BUENA VISTA AVE APT 113
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1992
Mailing Address - Country:US
Mailing Address - Phone:415-559-9663
Mailing Address - Fax:
Practice Address - Street 1:457 BUENA VISTA AVE APT 113
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1992
Practice Address - Country:US
Practice Address - Phone:415-559-9663
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1211671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical