Provider Demographics
NPI:1952650038
Name:DERGREGORIAN, JENNIFER ABIGAIL (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:ABIGAIL
Last Name:DERGREGORIAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:231 E BURBANK BLVD APT 102
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1044
Mailing Address - Country:US
Mailing Address - Phone:626-460-0327
Mailing Address - Fax:
Practice Address - Street 1:447 N EL MOLINO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101
Practice Address - Country:US
Practice Address - Phone:626-577-8480
Practice Address - Fax:626-577-8978
Is Sole Proprietor?:No
Enumeration Date:2012-09-05
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA2012308225C00000X
CA26841103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor