Provider Demographics
NPI:1306861505
Name:DUNKIN, JENNIFER JOY (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:JOY
Last Name:DUNKIN
Suffix:
Gender:F
Credentials:PHD
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Other - First Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM-PSYCHOLOGY # 116B
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0002
Mailing Address - Country:US
Mailing Address - Phone:858-642-6448
Mailing Address - Fax:858-552-7414
Practice Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM-PSYCHOLOGY # 116B
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0002
Practice Address - Country:US
Practice Address - Phone:858-642-6448
Practice Address - Fax:858-552-7414
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 14402103G00000X, 103T00000X
103TA0700X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS09589Medicare UPIN