Provider Demographics
NPI:1396046660
Name:REA, JEFFREY JOSEPH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:JOSEPH
Last Name:REA
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:626 WILSHIRE BLVD
Mailing Address - Street 2:STE 910
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-3209
Mailing Address - Country:US
Mailing Address - Phone:213-293-4925
Mailing Address - Fax:213-622-5633
Practice Address - Street 1:626 WILSHIRE BLVD
Practice Address - Street 2:STE 910
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-3209
Practice Address - Country:US
Practice Address - Phone:213-293-4925
Practice Address - Fax:213-622-5633
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-03
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical