Provider Demographics
NPI:1922311174
Name:TRIPATHY, JENNIFER DAWN (MFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:DAWN
Last Name:TRIPATHY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N SAN PEDRO RD
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94903-4178
Mailing Address - Country:US
Mailing Address - Phone:415-473-2502
Mailing Address - Fax:415-473-4307
Practice Address - Street 1:10 N SAN PEDRO RD
Practice Address - Street 2:SUITE 1020
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94903-4178
Practice Address - Country:US
Practice Address - Phone:415-473-2502
Practice Address - Fax:415-473-4307
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 44796106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist