Provider Demographics
NPI:1861865081
Name:WEINRAUB, JAKE ROSS (LMFT #112937)
Entity Type:Individual
Prefix:
First Name:JAKE
Middle Name:ROSS
Last Name:WEINRAUB
Suffix:
Gender:M
Credentials:LMFT #112937
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2116 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90018-1353
Mailing Address - Country:US
Mailing Address - Phone:323-334-9000
Mailing Address - Fax:213-553-1833
Practice Address - Street 1:2116 ARLINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90018-1353
Practice Address - Country:US
Practice Address - Phone:323-334-9000
Practice Address - Fax:213-553-1833
Is Sole Proprietor?:No
Enumeration Date:2015-11-10
Last Update Date:2022-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112937106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01536011OtherMEDI-CAL