Provider Demographics
NPI:1134911167
Name:ANDERSON, JAMAR DORREION
Entity type:Individual
Prefix:
First Name:JAMAR
Middle Name:DORREION
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:607 W 15TH ST APT 1
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-2224
Mailing Address - Country:US
Mailing Address - Phone:924-354-7869
Mailing Address - Fax:
Practice Address - Street 1:607 W 15TH ST APT 1
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-2224
Practice Address - Country:US
Practice Address - Phone:924-354-7869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-17
Last Update Date:2025-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst