Provider Demographics
NPI:1538574447
Name:BEROOL, JENNIFER AMITY
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:AMITY
Last Name:BEROOL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMITY
Other - Middle Name:JENNIFER
Other - Last Name:BEROOL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:SUDCC
Mailing Address - Street 1:2135 E ST
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93706
Mailing Address - Country:US
Mailing Address - Phone:559-268-6261
Mailing Address - Fax:559-268-7518
Practice Address - Street 1:539 N VAN NESS AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93728-3419
Practice Address - Country:US
Practice Address - Phone:559-266-9581
Practice Address - Fax:559-498-0507
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-30
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1851438410Medicaid