Provider Demographics
NPI:1649502642
Name:BRUGEL, JESSICA JILL (LCSW)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:JILL
Last Name:BRUGEL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 21ST ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-1605
Mailing Address - Country:US
Mailing Address - Phone:510-385-4300
Mailing Address - Fax:
Practice Address - Street 1:525 21ST ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1605
Practice Address - Country:US
Practice Address - Phone:510-385-4300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 255901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical