Provider Demographics
NPI:1124423058
Name:ABOUAV, JENNIFER
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:ABOUAV
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:744 SAN ANTONIO RD
Mailing Address - Street 2:#28
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94303-4632
Mailing Address - Country:US
Mailing Address - Phone:650-935-5279
Mailing Address - Fax:
Practice Address - Street 1:744 SAN ANTONIO RD
Practice Address - Street 2:#28
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-4632
Practice Address - Country:US
Practice Address - Phone:650-935-5279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-04
Last Update Date:2014-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW635241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical