Provider Demographics
NPI:1598074262
Name:JENNINGS, ROBERT A (LMFT)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:JENNINGS
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:PO BOX 11
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-0011
Mailing Address - Country:US
Mailing Address - Phone:909-631-6915
Mailing Address - Fax:626-208-4487
Practice Address - Street 1:954 N AMELIA AVE STE B
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1407
Practice Address - Country:US
Practice Address - Phone:909-631-6915
Practice Address - Fax:626-208-4487
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2010-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44774106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist