Provider Demographics
NPI:1396250668
Name:RONDINELLI, JENNIFER (MASTER EDUCATION)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:
Last Name:RONDINELLI
Suffix:
Gender:F
Credentials:MASTER EDUCATION
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 DOW AVE STE 122
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7247
Mailing Address - Country:US
Mailing Address - Phone:994-400-6522
Mailing Address - Fax:949-328-7689
Practice Address - Street 1:3002 DOW AVE STE 122
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7247
Practice Address - Country:US
Practice Address - Phone:994-400-6522
Practice Address - Fax:949-328-7689
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-08
Last Update Date:2017-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARBT-15-11422103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty