Provider Demographics
NPI:1013654227
Name:PRATT, JACOB ANDREW (MA)
Entity Type:Individual
Prefix:MR
First Name:JACOB
Middle Name:ANDREW
Last Name:PRATT
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 TEAL LN
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-5482
Mailing Address - Country:US
Mailing Address - Phone:339-223-0687
Mailing Address - Fax:
Practice Address - Street 1:2325 CLEMENT AVE
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-7063
Practice Address - Country:US
Practice Address - Phone:510-629-6367
Practice Address - Fax:510-306-1062
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health