Provider Demographics
NPI:1578228862
Name:FRONT, JEROME (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JEROME
Middle Name:
Last Name:FRONT
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12456 VENTURA BLVD STE 2A
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2484
Mailing Address - Country:US
Mailing Address - Phone:818-760-7725
Mailing Address - Fax:
Practice Address - Street 1:12456 VENTURA BLVD STE 2A
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-2484
Practice Address - Country:US
Practice Address - Phone:818-760-7725
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-02
Last Update Date:2021-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC30359101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health