Provider Demographics
NPI:1396864377
Name:MASSI, JENI MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:JENI
Middle Name:MARIE
Last Name:MASSI
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:PO BOX 902084
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93590-2084
Mailing Address - Country:US
Mailing Address - Phone:661-492-2378
Mailing Address - Fax:661-269-1858
Practice Address - Street 1:1607 E PALMDALE BLVD
Practice Address - Street 2:SUITE F
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4883
Practice Address - Country:US
Practice Address - Phone:661-492-2378
Practice Address - Fax:661-269-1858
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2019-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17854103TB0200X, 103TC2200X, 103TP2701X
CA17854103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy