Provider Demographics
NPI:1891881793
Name:LUNDY-AGUERRE, JENNIFER LYNN (LICENSED MARRIAGE AN)
Entity type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LYNN
Last Name:LUNDY-AGUERRE
Suffix:
Gender:F
Credentials:LICENSED MARRIAGE AN
Other - Prefix:MS
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:LUNDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICENSED MARRIAGE AN
Mailing Address - Street 1:5480 BALTIMORE DRIVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942
Mailing Address - Country:US
Mailing Address - Phone:619-733-6414
Mailing Address - Fax:619-303-3306
Practice Address - Street 1:5480 BALTIMORE DRIVE
Practice Address - Street 2:SUITE 250
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942
Practice Address - Country:US
Practice Address - Phone:619-733-6414
Practice Address - Fax:619-303-3306
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA42025106H00000X
CAMFC42025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist