Provider Demographics
NPI:1780786939
Name:ABBOTT, JEANNE ELAINE (LCSW)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:ELAINE
Last Name:ABBOTT
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 1:3300 TULLY RD
Mailing Address - Street 2:SUITE C-1
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-0836
Mailing Address - Country:US
Mailing Address - Phone:209-529-2084
Mailing Address - Fax:209-529-2282
Practice Address - Street 1:3300 TULLY RD
Practice Address - Street 2:SUITE C-1
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-0836
Practice Address - Country:US
Practice Address - Phone:209-529-2084
Practice Address - Fax:209-529-2282
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS9642104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ00258ZMedicare ID - Type Unspecified