Provider Demographics
NPI:1093966053
Name:BALLERINI, JENNIFER JANE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JANE
Last Name:BALLERINI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8080 MADISON AVE
Mailing Address - Street 2:STE 200 D
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-3759
Mailing Address - Country:US
Mailing Address - Phone:916-276-7709
Mailing Address - Fax:916-534-7753
Practice Address - Street 1:8080 MADISON AVE
Practice Address - Street 2:STE 200 D
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-3759
Practice Address - Country:US
Practice Address - Phone:916-276-7709
Practice Address - Fax:916-534-7753
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-08
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22155103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical