Provider Demographics
NPI:1952726721
Name:GASCON, JENNIFFER SAMATRA (MSW, ASW)
Entity type:Individual
Prefix:MRS
First Name:JENNIFFER
Middle Name:SAMATRA
Last Name:GASCON
Suffix:
Gender:F
Credentials:MSW, ASW
Other - Prefix:MS
Other - First Name:JENNIFFER
Other - Middle Name:VALERO
Other - Last Name:SAMATRA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1486 HUNTINGTON AVE
Mailing Address - Street 2:STE. 100
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5970
Mailing Address - Country:US
Mailing Address - Phone:650-877-8642
Mailing Address - Fax:
Practice Address - Street 1:1486 HUNTINGTON AVE
Practice Address - Street 2:STE. 100
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5970
Practice Address - Country:US
Practice Address - Phone:650-877-8642
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-03
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW60497104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker