Provider Demographics
NPI:1548619703
Name:DE LON, JACQUELINE
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:DE LON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:DE LON SUGARMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFT
Mailing Address - Street 1:3637 SACRAMENTO ST
Mailing Address - Street 2:SUITE F
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1723
Mailing Address - Country:US
Mailing Address - Phone:415-922-2608
Mailing Address - Fax:415-922-4438
Practice Address - Street 1:3637 SACRAMENTO ST
Practice Address - Street 2:SUITE F
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1723
Practice Address - Country:US
Practice Address - Phone:415-922-2608
Practice Address - Fax:415-922-4438
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2016-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102L00000X
CAMFT17279106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst