Provider Demographics
NPI:1588068183
Name:HUMPHREY, JAMIE LYNNE (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNNE
Last Name:HUMPHREY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:LYNNE
Other - Last Name:ST. JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:220 OAK MEADOW DR STE A
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-4407
Mailing Address - Country:US
Mailing Address - Phone:858-609-9354
Mailing Address - Fax:
Practice Address - Street 1:220 OAK MEADOW DR STE A
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-4407
Practice Address - Country:US
Practice Address - Phone:858-609-9354
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-10-10
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical