Provider Demographics
NPI:1902315773
Name:GROEBE, JENNIFER MARAQUITA (LCSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARAQUITA
Last Name:GROEBE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15079 ALEXANDRIA ST
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94579-1701
Mailing Address - Country:US
Mailing Address - Phone:510-551-8275
Mailing Address - Fax:
Practice Address - Street 1:4287 PIEDMONT AVE STE 107
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-4775
Practice Address - Country:US
Practice Address - Phone:510-551-8275
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-25
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA171911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA17191OtherLICENSE FOR CLINICAL SOCIAL WORK