Provider Demographics
NPI:1740304369
Name:MOGROVEJO, JENNIFFER YESENIA (MA MFT)
Entity type:Individual
Prefix:MS
First Name:JENNIFFER
Middle Name:YESENIA
Last Name:MOGROVEJO
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 PETITE CT
Mailing Address - Street 2:UNIT 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-2337
Mailing Address - Country:US
Mailing Address - Phone:626-376-0885
Mailing Address - Fax:
Practice Address - Street 1:2081 PALOS VERDES DR N
Practice Address - Street 2:
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3701
Practice Address - Country:US
Practice Address - Phone:310-517-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF#50999106H00000X
CAMFC51590106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist