Provider Demographics
NPI:1902408941
Name:MEROVICK, JENNIE (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIE
Middle Name:
Last Name:MEROVICK
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:PO BOX 7262
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-0262
Mailing Address - Country:US
Mailing Address - Phone:707-366-0272
Mailing Address - Fax:
Practice Address - Street 1:924 MENDOCINO AVE
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-1925
Practice Address - Country:US
Practice Address - Phone:510-332-7834
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical