Provider Demographics
NPI:1821536798
Name:REZNICK, JENNY (MFT)
Entity Type:Individual
Prefix:MRS
First Name:JENNY
Middle Name:
Last Name:REZNICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 HAMPSHIRE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-2510
Mailing Address - Country:US
Mailing Address - Phone:805-497-0605
Mailing Address - Fax:
Practice Address - Street 1:650 HAMPSHIRE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-2510
Practice Address - Country:US
Practice Address - Phone:805-497-0605
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-10
Last Update Date:2017-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC53580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist