Provider Demographics
NPI:1174876569
Name:CAMARENO, JENNIFER BROOKE (MFT)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:BROOKE
Last Name:CAMARENO
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 1:650 SIERRA MADRE VILLA AVE STE 110
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-2000
Mailing Address - Country:US
Mailing Address - Phone:626-351-9616
Mailing Address - Fax:
Practice Address - Street 1:325 E SHORE DR STE 120
Practice Address - Street 2:
Practice Address - City:EAGLE
Practice Address - State:ID
Practice Address - Zip Code:83616-6584
Practice Address - Country:US
Practice Address - Phone:208-464-8806
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2023-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT90338106H00000X
IDMFT-8238106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist