Provider Demographics
NPI:1972600617
Name:RITTENHOUSE, JACKIE (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JACKIE
Middle Name:
Last Name:RITTENHOUSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:RITTENHOUSE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2091 BAJA VISTA WAY
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-9281
Mailing Address - Country:US
Mailing Address - Phone:805-987-3921
Mailing Address - Fax:
Practice Address - Street 1:155 GRANADA ST
Practice Address - Street 2:SUITE P
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010-7725
Practice Address - Country:US
Practice Address - Phone:805-216-6445
Practice Address - Fax:805-388-9455
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40010106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist