Provider Demographics
NPI:1265628770
Name:KERECMANMARTIN, JENNIFER ALAINE (MSW)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ALAINE
Last Name:KERECMANMARTIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:A
Other - Last Name:KERECMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:950 SHADOW ROCK DR
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-8446
Mailing Address - Country:US
Mailing Address - Phone:916-398-0454
Mailing Address - Fax:
Practice Address - Street 1:950 SHADOW ROCK DR
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-8446
Practice Address - Country:US
Practice Address - Phone:916-398-0454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-18
Last Update Date:2024-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA82517101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health