Basic Information
| Provider Information | |||||||||
| NPI: | 1376982488 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CAMARCO | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | WONG | ||||||||
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| Credential: | MS., LMFT | ||||||||
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| OtherLastName: | WONG | ||||||||
| OtherFirstName: | JANE | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2505 MIRAMAR AVE APT 136 | ||||||||
| Address2: | |||||||||
| City: | CASTRO VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945462845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107053231 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1500 FRANKLIN ST | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 941094523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154747310 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/21/2013 | ||||||||
| LastUpdateDate: | 06/23/2017 | ||||||||
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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 | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 101YM0800X | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | IMF89132 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 100275 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.