Provider Demographics
NPI:1346508447
Name:TANSEY, JENNIFER HART (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:HART
Last Name:TANSEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2627 LAKE AVE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-1025
Mailing Address - Country:US
Mailing Address - Phone:949-636-2786
Mailing Address - Fax:
Practice Address - Street 1:2500 VIA CABRILLO MARINA
Practice Address - Street 2:ST #200A-1
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-7224
Practice Address - Country:US
Practice Address - Phone:949-636-2786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-26
Last Update Date:2016-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA#PSY17959103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist