1326064841 NPI number — MRS. JACALYN R. OSTROVE-GREENBERG LMFT

Table of content: MRS. JACALYN R. OSTROVE-GREENBERG LMFT (NPI 1326064841)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326064841 NPI number — MRS. JACALYN R. OSTROVE-GREENBERG LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OSTROVE-GREENBERG
Provider First Name:
JACALYN
Provider Middle Name:
R.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326064841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4629 CONCHITA WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARZANA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91356-4905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-708-3358
Provider Business Mailing Address Fax Number:
818-708-7667

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4629 CONCHITA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARZANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91356-4905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-708-3358
Provider Business Practice Location Address Fax Number:
818-708-7667
Provider Enumeration Date:
07/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  MFC16522 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: MFC16522 . This is a "MFT STATE LICENSE" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".