Provider Demographics
NPI:1437353380
Name:REINA, JESSICA (PSYD)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:REINA
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 1:9650 ZELZAH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-2003
Mailing Address - Country:US
Mailing Address - Phone:818-993-9311
Mailing Address - Fax:
Practice Address - Street 1:8550 BALBOA BLVD STE 150
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-3579
Practice Address - Country:US
Practice Address - Phone:818-830-0200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27022103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical