Provider Demographics
NPI:1548439003
Name:BIRCH, JENNIFER SIMPSON (PMHNP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:SIMPSON
Last Name:BIRCH
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2397 SHATTUCK AVE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1567
Mailing Address - Country:US
Mailing Address - Phone:510-599-9421
Mailing Address - Fax:949-656-7728
Practice Address - Street 1:2397 SHATTUCK AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1567
Practice Address - Country:US
Practice Address - Phone:510-599-9421
Practice Address - Fax:949-656-7728
Is Sole Proprietor?:No
Enumeration Date:2008-02-28
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18162363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACY849ZMedicare PIN