Provider Demographics
NPI:1164170221
Name:BODINET, JELENA CINGEL (AMFT)
Entity Type:Individual
Prefix:
First Name:JELENA
Middle Name:CINGEL
Last Name:BODINET
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7734 HERSHEL AVENUE
Mailing Address - Street 2:SUITE I
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037
Mailing Address - Country:US
Mailing Address - Phone:619-787-6667
Mailing Address - Fax:
Practice Address - Street 1:7734 HERSHEL AVENUE
Practice Address - Street 2:SUITE I
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037
Practice Address - Country:US
Practice Address - Phone:619-787-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT131257106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist