Provider Demographics
NPI:1386075398
Name:KEMP, JENNA MAUREEN (MFTI)
Entity type:Individual
Prefix:MS
First Name:JENNA
Middle Name:MAUREEN
Last Name:KEMP
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 EDGEMAR AVE
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044-1961
Mailing Address - Country:US
Mailing Address - Phone:650-877-8642
Mailing Address - Fax:650-355-2850
Practice Address - Street 1:435 EDGEMAR AVE
Practice Address - Street 2:
Practice Address - City:PACIFICA
Practice Address - State:CA
Practice Address - Zip Code:94044-1961
Practice Address - Country:US
Practice Address - Phone:650-877-8642
Practice Address - Fax:650-355-2850
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA77305101YM0800X, 251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77305Medicaid
CA77305Medicare PIN