Healthcare Provider Details

I. General information

NPI: 1407523681
Provider Name (Legal Business Name): JENNA LAUREN ZUCKER LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 03/12/2024
Certification Date: 03/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3928 OLEANDER CT APT E
CALABASAS CA
91302-3521
US

IV. Provider business mailing address

3928 OLEANDER CT APT E
CALABASAS CA
91302-3521
US

V. Phone/Fax

Practice location:
  • Phone: 818-585-4799
  • Fax:
Mailing address:
  • Phone: 818-585-4799
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number145162
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: