Provider Demographics
NPI:1831674829
Name:KINOSHITA, JAMIE (ASW)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:KINOSHITA
Suffix:
Gender:F
Credentials:ASW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:
Other - Last Name:CRISOSTOMO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ASW
Mailing Address - Street 1:3075 ADELINE ST STE 120
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2579
Mailing Address - Country:US
Mailing Address - Phone:510-848-1112
Mailing Address - Fax:
Practice Address - Street 1:3075 ADELINE ST STE 120
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94703-2579
Practice Address - Country:US
Practice Address - Phone:510-848-1112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-26
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor