Provider Demographics
NPI:1770977589
Name:BUSICO, JENNIFER (LMFT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BUSICO
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 1:731 S HIGHWAY 101 STE 1E
Mailing Address - Street 2:
Mailing Address - City:SOLANA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92075-2628
Mailing Address - Country:US
Mailing Address - Phone:858-230-0110
Mailing Address - Fax:
Practice Address - Street 1:731 S HIGHWAY 101 STE 1E
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2628
Practice Address - Country:US
Practice Address - Phone:858-230-0110
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA83552106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist