Provider Demographics
NPI:1558477851
Name:DUGAN, JENNIFER MANESS (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:MANESS
Last Name:DUGAN
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 21449
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90801-4449
Mailing Address - Country:US
Mailing Address - Phone:562-590-9905
Mailing Address - Fax:562-612-0015
Practice Address - Street 1:4401 ATLANTIC AVE STE 220
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2218
Practice Address - Country:US
Practice Address - Phone:310-621-0335
Practice Address - Fax:562-984-2087
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 13736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical