1265659270 NPI number — MS. JANE MARIE REARDON MA. MFT

Table of content: MS. JANE MARIE REARDON MA. MFT (NPI 1265659270)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265659270 NPI number — MS. JANE MARIE REARDON MA. MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
REARDON
Provider First Name:
JANE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MA. MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
REARDON
Provider Other First Name:
JANE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MA, MFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1265659270
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:
5860 CANYON CV
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90068-3025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-599-0243
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8235 SANTA MONICA BLVD
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
WEST HOLLYWOOD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90046-5914
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-599-0243
Provider Business Practice Location Address Fax Number:
323-871-1108
Provider Enumeration Date:
04/19/2007

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: 106H00000X , with the licence number:  MFC 43565 , 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)





Copyright © 2007-2025 www.npivalidator.com