Jennifer Athanacio
Marriage & Family Therapist in Fremont, CA. Individual provider (NPI-1).
NPI number1457172157
StatusActive
Last updated in NPPESOct 24, 2024
Details
- NPI
- 1457172157
- Entity type
- Individual (NPI-1)
- Name
- Jennifer Athanacio
- Sex
- Female
- Sole proprietor
- No
- Enumeration date
- Oct 24, 2024
- Certification date
- Oct 24, 2024
- Last updated
- Oct 24, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | 99356 | CA | Yes |
| 103TS0200X | Psychologist, School | – | CA |
Practice location
4210 Technology DrFremont, CA 94538-6337
Phone 510-329-2045
Mailing address
1844 Catalpa WayHayward, CA 94545-4956
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