Provider Demographics
NPI:1265659270
Name:REARDON, JANE MARIE (MA MFT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:REARDON
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:
Other - Last Name:REARDON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA, MFT
Mailing Address - Street 1:5860 CANYON CV
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90068-3025
Mailing Address - Country:US
Mailing Address - Phone:323-599-0243
Mailing Address - Fax:
Practice Address - Street 1:8235 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 400
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-5914
Practice Address - Country:US
Practice Address - Phone:323-599-0243
Practice Address - Fax:323-871-1108
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43565106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist