Basic Information
| Provider Information | |||||||||
| NPI: | 1245281898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SARMIENTO | ||||||||
| FirstName: | JEANETTE | ||||||||
| MiddleName: | DORA | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2001 DWIGHT WAY | ||||||||
| Address2: | BERKELEY PRIMARY CARE, ROOM 1363 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102044666 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2001 DWIGHT WAY | ||||||||
| Address2: | BERKELEY PRIMARY CARE, ROOM 1363 | ||||||||
| City: | BERKELEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947042608 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5102044666 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2006 | ||||||||
| LastUpdateDate: | 07/16/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 20281 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.