Provider Demographics
NPI:1699052837
Name:MANDERSCHEID, JENNIFER LYNN (MA MFT)
Entity type:Individual
Prefix:MISS
First Name:JENNIFER
Middle Name:LYNN
Last Name:MANDERSCHEID
Suffix:
Gender:F
Credentials:MA MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 VILLAGE PARK WAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-1994
Mailing Address - Country:US
Mailing Address - Phone:858-633-6760
Mailing Address - Fax:760-487-5453
Practice Address - Street 1:1991 VILLAGE PARK WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-1994
Practice Address - Country:US
Practice Address - Phone:858-633-6760
Practice Address - Fax:760-487-5453
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50683106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist