Provider Demographics
NPI:1851583595
Name:DEFRATES, JADE ELIZABETH (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:JADE
Middle Name:ELIZABETH
Last Name:DEFRATES
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1053
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-8053
Mailing Address - Country:US
Mailing Address - Phone:925-628-5888
Mailing Address - Fax:925-270-1909
Practice Address - Street 1:201 SAND CREEK RD STE G-1
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2124
Practice Address - Country:US
Practice Address - Phone:925-628-5888
Practice Address - Fax:925-270-1909
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2016-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 238701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical