Provider Demographics
NPI:1720528763
Name:HASENSTAUB, JENNIFER BROWN (LMFT)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:BROWN
Last Name:HASENSTAUB
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S BUENA VISTA ST APT A
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4513
Mailing Address - Country:US
Mailing Address - Phone:818-861-9810
Mailing Address - Fax:
Practice Address - Street 1:4405 W RIVERSIDE DR STE 203
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4050
Practice Address - Country:US
Practice Address - Phone:818-238-9895
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-23
Last Update Date:2017-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA98050106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist