Provider Demographics
NPI:1235318668
Name:CALDERON, JENNIFER REBECCA (LMFT, LPCC)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:REBECCA
Last Name:CALDERON
Suffix:
Gender:F
Credentials:LMFT, LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28310 ROADSIDE DR STE 202D
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4958
Mailing Address - Country:US
Mailing Address - Phone:818-720-4494
Mailing Address - Fax:
Practice Address - Street 1:28310 ROADSIDE DR STE 202D
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4958
Practice Address - Country:US
Practice Address - Phone:818-720-4494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-01
Last Update Date:2025-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA796101YP2500X
CA45687106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional