Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PSY 20063 | CA |
Y | 103T00000X | Psychologist | PSY 20063 | CA |
NPI | 1003847732 |
---|---|
Provider Name | Dr. Cheryl Jacques |
First Address | Oakland, CA 94618-1655 |
Second Address | Oakland, CA 94618-1655 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2006 |
Last Update Date | 08/07/2007 |