MEDICARE: JENNIFER DEL GALLO 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
1	106H00000X	Marriage & Family Therapist	102151	CA

General Provider Information

NPI Number	:	1447760434
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER DEL GALLO LMFT

Provider Business Mailing Address
First Line	:	17797 ASH ST
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4501
Country	:	US
Telephone Number	:	507-254-7835
Fax Number	:

Provider Business Practice Location Address
First Line	:	18811 HUNTINGTON ST STE 200
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6003
Country	:	US
Telephone Number	:	507-254-7835
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/04/2017
Last Update Date	:	10/04/2017

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