Provider Demographics
NPI:1801002795
Name:ANDREWS, JENNIFER D (MFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:D
Last Name:ANDREWS
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1257 ODDSTAD BLVD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-3852
Mailing Address - Country:US
Mailing Address - Phone:650-355-2138
Mailing Address - Fax:
Practice Address - Street 1:1305 PALMETTO AVE STE A
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-2274
Practice Address - Country:US
Practice Address - Phone:415-518-2914
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA43989106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist