Provider Demographics
NPI:1780947366
Name:DENTICI, JENNIFER ANN
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:DENTICI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:659 ABREGO ST
Mailing Address - Street 2:STE. 5
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-3238
Mailing Address - Country:US
Mailing Address - Phone:831-760-9010
Mailing Address - Fax:
Practice Address - Street 1:659 ABREGO ST
Practice Address - Street 2:STE. 5
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3238
Practice Address - Country:US
Practice Address - Phone:831-760-9010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86895106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist