Healthcare Provider Details

I. General information

NPI: 1841470937
Provider Name (Legal Business Name): JENNIFER CAWELTI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/06/2007
Last Update Date: 11/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

IV. Provider business mailing address

5414 NEWCASTLE AVE APT 2
ENCINO CA
91316-2037
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-3423
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number54944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: