Provider Demographics
NPI:1154335172
Name:CARDILLO, JENNIFER LYN (MA)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:LYN
Last Name:CARDILLO
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MISS
Other - First Name:JENNIFER
Other - Middle Name:LYN
Other - Last Name:STRAUSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2595 E PERRIN AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5202
Mailing Address - Country:US
Mailing Address - Phone:559-824-2277
Mailing Address - Fax:
Practice Address - Street 1:2595 E PERRIN AVE STE 113
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93720-5202
Practice Address - Country:US
Practice Address - Phone:559-824-2277
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 41706106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist