Provider Demographics
NPI:1619006368
Name:HEROLD, JESSICA (MA, MFTI)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:HEROLD
Suffix:
Gender:F
Credentials:MA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1590 SACRAMENTO ST APT 32
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3825
Mailing Address - Country:US
Mailing Address - Phone:415-218-6336
Mailing Address - Fax:
Practice Address - Street 1:1530 BUCHANAN ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3709
Practice Address - Country:US
Practice Address - Phone:650-355-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist