Provider Demographics
NPI:1831668029
Name:BELL, JEAN M (LCSW)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:BELL
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 1:39400 PASEO PADRE PKWY
Mailing Address - Street 2:NEUROLOGY DEPT.
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2310
Mailing Address - Country:US
Mailing Address - Phone:510-248-3354
Mailing Address - Fax:510-248-6157
Practice Address - Street 1:39400 PASEO PADRE PKWY
Practice Address - Street 2:NEUROLOGY DEPT.
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2310
Practice Address - Country:US
Practice Address - Phone:510-248-3354
Practice Address - Fax:510-248-6157
Is Sole Proprietor?:No
Enumeration Date:2018-11-16
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-174541041C0700X
CALCS240211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical