Provider Demographics
NPI:1366272858
Name:HERNANDEZ COLACICCO, JESSICA PASARET
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:PASARET
Last Name:HERNANDEZ COLACICCO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 SENDA LADERA
Mailing Address - Street 2:
Mailing Address - City:APTOS HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95076-8805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:294 GREEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-1300
Practice Address - Country:US
Practice Address - Phone:831-786-2130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-07
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA130233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist