Provider Demographics
NPI:1669127098
Name:ANTON, JENNIFER JABER (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:JABER
Last Name:ANTON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1788
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-0204
Mailing Address - Country:US
Mailing Address - Phone:510-698-1807
Mailing Address - Fax:
Practice Address - Street 1:1425 BROADWAY STE 18
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3448
Practice Address - Country:US
Practice Address - Phone:510-698-1807
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-02-14
Last Update Date:2022-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA91202106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist