Provider Demographics
NPI:1861627747
Name:MARSH, JENNIFER LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:MARSH
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 1:2748 COREY PL
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94583-2407
Mailing Address - Country:US
Mailing Address - Phone:408-901-9116
Mailing Address - Fax:
Practice Address - Street 1:2603 CAMINO RAMON
Practice Address - Street 2:STE 433
Practice Address - City:SAN RAMON
Practice Address - State:CA
Practice Address - Zip Code:94583-9129
Practice Address - Country:US
Practice Address - Phone:925-444-0821
Practice Address - Fax:925-475-8249
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW696081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical