Provider Demographics
NPI:1720319874
Name:MARSALA, JENNA LANE (MA)
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:LANE
Last Name:MARSALA
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 HARBOR WAY # 227
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93109-2300
Mailing Address - Country:US
Mailing Address - Phone:925-285-5441
Mailing Address - Fax:
Practice Address - Street 1:4 PASO HONDO
Practice Address - Street 2:
Practice Address - City:CARMEL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93924-9642
Practice Address - Country:US
Practice Address - Phone:925-285-5441
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-28
Last Update Date:2020-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
53949101YM0800X
CA53949106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health