Provider Demographics
NPI:1043362668
Name:PAUL, JENNY MARCELLINO (MA MFT)
Entity type:Individual
Prefix:MISS
First Name:JENNY
Middle Name:MARCELLINO
Last Name:PAUL
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 STATE ST
Mailing Address - Street 2:#19
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93101-2710
Mailing Address - Country:US
Mailing Address - Phone:831-325-6086
Mailing Address - Fax:
Practice Address - Street 1:1029 STATE ST
Practice Address - Street 2:#19
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-2710
Practice Address - Country:US
Practice Address - Phone:831-325-6086
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
CA53173106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor