Provider Demographics
NPI:1013330844
Name:PASCAL, JENNIFER
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:PASCAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:PASCAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MASTERS
Mailing Address - Street 1:10516 SANTA MONICA BLVD
Mailing Address - Street 2:SUTIE #1
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4964
Mailing Address - Country:US
Mailing Address - Phone:310-893-0278
Mailing Address - Fax:
Practice Address - Street 1:10516 SANTA MONICA BLVD
Practice Address - Street 2:SUITE #1
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-4964
Practice Address - Country:US
Practice Address - Phone:310-893-0278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-30
Last Update Date:2014-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49476106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist