Provider Demographics
NPI:1194919886
Name:D'MEZA, JACQUELINE JOYCE (LMFT)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:JOYCE
Last Name:D'MEZA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 S LA BREA AVE
Mailing Address - Street 2:SUIT 11
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90016-2807
Mailing Address - Country:US
Mailing Address - Phone:626-393-9193
Mailing Address - Fax:323-292-4633
Practice Address - Street 1:4247 W 61ST ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90043-3608
Practice Address - Country:US
Practice Address - Phone:323-292-4633
Practice Address - Fax:323-292-4633
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-05
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC40249106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist