Provider Demographics
NPI:1326064841
Name:OSTROVE-GREENBERG, JACALYN R (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACALYN
Middle Name:R
Last Name:OSTROVE-GREENBERG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4629 CONCHITA WAY
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4905
Mailing Address - Country:US
Mailing Address - Phone:818-708-3358
Mailing Address - Fax:818-708-7667
Practice Address - Street 1:4629 CONCHITA WAY
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-4905
Practice Address - Country:US
Practice Address - Phone:818-708-3358
Practice Address - Fax:818-708-7667
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC16522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMFC16522OtherMFT STATE LICENSE