Provider Demographics
NPI:1568096527
Name:FUJIWARA, KERI REIKO (MA, MS)
Entity type:Individual
Prefix:
First Name:KERI
Middle Name:REIKO
Last Name:FUJIWARA
Suffix:
Gender:F
Credentials:MA, MS
Other - Prefix:
Other - First Name:KERI
Other - Middle Name:REIKO
Other - Last Name:FUJIWARA R
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:2727 CAMINO DEL RIO S STE 123
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3739
Mailing Address - Country:US
Mailing Address - Phone:619-894-7376
Mailing Address - Fax:
Practice Address - Street 1:2727 CAMINO DEL RIO S STE 123
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3739
Practice Address - Country:US
Practice Address - Phone:619-894-7376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-28
Last Update Date:2024-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139100106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health