Provider Demographics
NPI:1780036533
Name:BRAKE, JENNIFER J (MFTI)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:J
Last Name:BRAKE
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:JJ
Other - Middle Name:
Other - Last Name:BRAKE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFTI
Mailing Address - Street 1:28 N OAK AVE
Mailing Address - Street 2:204
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-5870
Mailing Address - Country:US
Mailing Address - Phone:626-219-2913
Mailing Address - Fax:
Practice Address - Street 1:28 N OAK AVE
Practice Address - Street 2:204
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-5870
Practice Address - Country:US
Practice Address - Phone:626-219-2913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-05
Last Update Date:2016-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist