Provider Demographics
NPI:1538418280
Name:SERRA, JEANNE (LMFT, PPSC)
Entity type:Individual
Prefix:
First Name:JEANNE
Middle Name:
Last Name:SERRA
Suffix:
Gender:F
Credentials:LMFT, PPSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 ARAGON DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-5910
Mailing Address - Country:US
Mailing Address - Phone:510-386-4065
Mailing Address - Fax:
Practice Address - Street 1:2535 CAMINO DEL RIO S
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3754
Practice Address - Country:US
Practice Address - Phone:619-728-6917
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103344106H00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health