Basic Information
| Provider Information | |||||||||
| NPI: | 1891881793 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LUNDY-AGUERRE | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LICENSED MARRIAGE AN | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | LUNDY | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
| OtherMiddleName: | LYNN | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LICENSED MARRIAGE AN | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 5480 BALTIMORE DRIVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197336414 | ||||||||
| FaxNumber: | 6193033306 | ||||||||
| Practice Location | |||||||||
| Address1: | 5480 BALTIMORE DRIVE | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | LA MESA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91942 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6197336414 | ||||||||
| FaxNumber: | 6193033306 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/05/2006 | ||||||||
| LastUpdateDate: | 10/18/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 42025 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | MFC42025 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.