Provider Demographics
NPI:1265696736
Name:MALLARI, JENNIFER LYNETTE CLARK (MA, MDIV)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNETTE CLARK
Last Name:MALLARI
Suffix:
Gender:F
Credentials:MA, MDIV
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNETTE
Other - Last Name:CLARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:13666 E 14TH ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94578-2538
Mailing Address - Country:US
Mailing Address - Phone:510-357-5515
Mailing Address - Fax:510-357-5112
Practice Address - Street 1:13666 E 14TH ST
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-2538
Practice Address - Country:US
Practice Address - Phone:510-357-5515
Practice Address - Fax:510-357-5112
Is Sole Proprietor?:No
Enumeration Date:2008-07-15
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health