Provider Demographics
NPI:1902974041
Name:HESBOL, JENNIFER RENAE (MFT)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:RENAE
Last Name:HESBOL
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:704 DURHAM PL
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-1245
Mailing Address - Country:US
Mailing Address - Phone:415-517-4506
Mailing Address - Fax:
Practice Address - Street 1:704 DURHAM PL
Practice Address - Street 2:
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-1245
Practice Address - Country:US
Practice Address - Phone:415-517-4506
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2014-03-27
Deactivation Date:2010-11-24
Deactivation Code:
Reactivation Date:2012-09-11
Provider Licenses
StateLicense IDTaxonomies
CAMFC 48743106H00000X
PAMF000765106H00000X
171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA41178OtherCOUNTY ID