Provider Demographics
NPI:1245362219
Name:DRENTH, JILL
Entity type:Individual
Prefix:
First Name:JILL
Middle Name:
Last Name:DRENTH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1328 SECOND STREET
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401
Mailing Address - Country:US
Mailing Address - Phone:310-576-1308
Mailing Address - Fax:310-394-6883
Practice Address - Street 1:6762 LEXINGTON AVE
Practice Address - Street 2:STE A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90038
Practice Address - Country:US
Practice Address - Phone:323-380-7590
Practice Address - Fax:323-380-7591
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA289791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical