Provider Demographics
NPI:1245898196
Name:WERNER, JENNIFER RANAE
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RANAE
Last Name:WERNER
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 1:3124 LA SELVA CIR APT 8
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94403-2141
Mailing Address - Country:US
Mailing Address - Phone:408-449-9677
Mailing Address - Fax:
Practice Address - Street 1:3124 LA SELVA CIR APT 8
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94403-2141
Practice Address - Country:US
Practice Address - Phone:408-449-9677
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)