Provider Demographics
NPI:1609995299
Name:REYES, JERNA (LMFT)
Entity Type:Individual
Prefix:
First Name:JERNA
Middle Name:
Last Name:REYES
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 1:1380 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94103-2638
Mailing Address - Country:US
Mailing Address - Phone:415-255-3752
Mailing Address - Fax:415-255-3057
Practice Address - Street 1:1380 HOWARD ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2638
Practice Address - Country:US
Practice Address - Phone:415-255-3752
Practice Address - Fax:415-255-3057
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC46958106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
5117OtherCBHS INTERNAL USE ONLY-COMMERCIAL NUMBER
5117OtherSFGH INTERNAL USE ONLY