Provider Demographics
NPI:1336271931
Name:DUKE, JENNIFER J (MFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:J
Last Name:DUKE
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 1:410 W STOCKER ST APT A
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-4309
Mailing Address - Country:US
Mailing Address - Phone:818-547-1654
Mailing Address - Fax:
Practice Address - Street 1:867 ATCHISON ST
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91104-2314
Practice Address - Country:US
Practice Address - Phone:626-798-0915
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42153106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist