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General NPI Number Information
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NPI Number | 1265659270
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Entity Type | Individual
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Provider Name | JANE MARIE REARDON MA. MFT
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Gender | Female
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Dates
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Enumeration Date | 04/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 8235 SANTA MONICA BLVD SUITE 400
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90046-5914
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Country | US
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Telephone | 323-599-0243
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Fax | 323-871-1108
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Provider Business Mailing Address
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Address Line | 5860 CANYON CV
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City | LOS ANGELES
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State | CA
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Zip | 90068-3025
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Country | US
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Telephone | 323-599-0243
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 43565
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License Number State | CA
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