Provider Demographics
NPI:1184062333
Name:JANSSEN, JENNICA (PHD, JD)
Entity type:Individual
Prefix:DR
First Name:JENNICA
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:PHD, JD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3631 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2942
Mailing Address - Country:US
Mailing Address - Phone:650-504-0494
Mailing Address - Fax:
Practice Address - Street 1:3101 OCEAN PARK BLVD STE 100
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-3029
Practice Address - Country:US
Practice Address - Phone:844-287-4228
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-10
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1184062333OtherPSYCHOLOGY