Most Relevant Information
Provider Data
| NPI Number: | 1003299801 |
| Provider Name: | JEAN BROADNAX LCSW |
| Entity Type: | Individual |
| Taxonomy Code: | 1041C0700X |
| Specialty: | Social Worker |
| License Number: | 27385 |
Most Important Dates
| Enumeration Date: | 06/30/2015 |
| Last Updated: | 11/26/2021 |
Provider Practice Location
975 SERENO DR
VALLEJO
CA
945892441
Practice Location Phone/Fax
| Phone: | 7076514423 |
| Fax: |
Provider Mailing Location
975 SERENO DR
VALLEJO
CA
945892441
Provider Mailing Phone/Fax
| Phone: | 7076514423 |
| Fax: |