Provider Demographics
NPI:1073944088
Name:GENDRON, GERALYN CAROL (MFT)
Entity Type:Individual
Prefix:
First Name:GERALYN
Middle Name:CAROL
Last Name:GENDRON
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:GERALYN
Other - Middle Name:
Other - Last Name:GENDREAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3035 SEAVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93001-4241
Mailing Address - Country:US
Mailing Address - Phone:415-419-6448
Mailing Address - Fax:
Practice Address - Street 1:3035 SEAVIEW AVE
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-4241
Practice Address - Country:US
Practice Address - Phone:415-419-6448
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health