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NPI Code Detail

MEDICARE: JENNIFER MARIA ANDERSEN LMFT

MEDICARE: JENNIFER MARIA ANDERSEN LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC39509CA

General Provider Information

NPI Number : 1558490565
Entity Type Code : Individual
Provider Name (Legal Business Name) : JENNIFER MARIA ANDERSEN LMFT
Provider Business Mailing Address
First Line : 2385 ROSCOMARE RD APT F7
Second Line :
City : LOS ANGELES
State : CA
Zip : 90077-1822
Country : US
Telephone Number : 310-440-0644
Fax Number :
Provider Business Practice Location Address
First Line : 601 S GLENOAKS BLVD STE 200
Second Line :
City : BURBANK
State : CA
Zip : 91502-2787
Country : US
Telephone Number : 818-441-7800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/05/2007
Last Update Date : 07/08/2007

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