Provider Demographics
NPI:1700990892
Name:JONES, MARVIN WILLARD (PHD,LCSW)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:WILLARD
Last Name:JONES
Suffix:
Gender:M
Credentials:PHD,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:465 34TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-2815
Mailing Address - Country:US
Mailing Address - Phone:510-658-3364
Mailing Address - Fax:510-658-3299
Practice Address - Street 1:465 34TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-2815
Practice Address - Country:US
Practice Address - Phone:510-658-3364
Practice Address - Fax:510-658-3299
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS39571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical