Provider Demographics
NPI:1932319522
Name:RICE, JEVON RENEE (PSYCH ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:JEVON
Middle Name:RENEE
Last Name:RICE
Suffix:
Gender:F
Credentials:PSYCH ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2222 BANCROFT WAY SPC 4300
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94720-4304
Mailing Address - Country:US
Mailing Address - Phone:510-642-9336
Mailing Address - Fax:510-642-2368
Practice Address - Street 1:2222 BANCROFT WAY SPC 4300
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94720-4304
Practice Address - Country:US
Practice Address - Phone:510-642-9336
Practice Address - Fax:510-642-2368
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94025534101YM0800X
MA8143101YM0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health