Provider Demographics
NPI:1396807541
Name:RANIERI, JASON DREW (LMFT)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:DREW
Last Name:RANIERI
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 ESTUDILLO AVE STE D
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-4923
Mailing Address - Country:US
Mailing Address - Phone:510-345-1731
Mailing Address - Fax:
Practice Address - Street 1:444 ESTUDILLO AVE STE D
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-4923
Practice Address - Country:US
Practice Address - Phone:510-345-1731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52975106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7740Medicaid