Provider Demographics
NPI:1114703907
Name:MOSCONE MANZANEDO, JENIFER ANN (LMFT/LPCC TRAINEE)
Entity Type:Individual
Prefix:MS
First Name:JENIFER
Middle Name:ANN
Last Name:MOSCONE MANZANEDO
Suffix:
Gender:F
Credentials:LMFT/LPCC TRAINEE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:668 CEDAR ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-3039
Mailing Address - Country:US
Mailing Address - Phone:650-430-7356
Mailing Address - Fax:
Practice Address - Street 1:335 QUARRY RD
Practice Address - Street 2:
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-6217
Practice Address - Country:US
Practice Address - Phone:650-591-3636
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-06
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)