Provider Demographics
NPI:1265557136
Name:WOLFSON, JENNA EYTON (LCSW)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:EYTON
Last Name:WOLFSON
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 1:780 CONDOR AVE # A
Mailing Address - Street 2:
Mailing Address - City:BEN LOMOND
Mailing Address - State:CA
Mailing Address - Zip Code:95005-9645
Mailing Address - Country:US
Mailing Address - Phone:805-904-8583
Mailing Address - Fax:
Practice Address - Street 1:6630 HIGHWAY 9 STE 204
Practice Address - Street 2:
Practice Address - City:FELTON
Practice Address - State:CA
Practice Address - Zip Code:95018-9711
Practice Address - Country:US
Practice Address - Phone:805-904-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA609301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical