Provider Demographics
NPI:1598373326
Name:ALONZO, JENNIFER CLARISSA (APCC)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:CLARISSA
Last Name:ALONZO
Suffix:
Gender:F
Credentials:APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8739 SANTA MONICA BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90069-4507
Mailing Address - Country:US
Mailing Address - Phone:310-623-1477
Mailing Address - Fax:310-854-0134
Practice Address - Street 1:8739 SANTA MONICA BLVD
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90069-4507
Practice Address - Country:US
Practice Address - Phone:310-623-1477
Practice Address - Fax:310-854-0134
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2021-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA9902101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional