Provider Demographics
NPI:1659602621
Name:HERNANDEZ-ARCENEAUX, JENNIFER LAUREN
Entity Type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LAUREN
Last Name:HERNANDEZ-ARCENEAUX
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LAUREN
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:3031 S VERMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90007-3033
Mailing Address - Country:US
Mailing Address - Phone:323-373-2400
Mailing Address - Fax:
Practice Address - Street 1:3031 S VERMONT AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90007-3033
Practice Address - Country:US
Practice Address - Phone:323-373-2400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-14
Last Update Date:2013-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA64483101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health