Provider Demographics
NPI:1669818225
Name:OYITE, JENNA ELISE
Entity type:Individual
Prefix:
First Name:JENNA
Middle Name:ELISE
Last Name:OYITE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JENNA
Other - Middle Name:ELISE
Other - Last Name:LIPPINCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:710 S MYRTLE AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:MONROVIA
Mailing Address - State:CA
Mailing Address - Zip Code:91016-3423
Mailing Address - Country:US
Mailing Address - Phone:626-775-7726
Mailing Address - Fax:
Practice Address - Street 1:710 S MYRTLE AVE STE 111
Practice Address - Street 2:SUITE D
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-3423
Practice Address - Country:US
Practice Address - Phone:626-775-7726
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-21
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW66412101YM0800X
390200000X
CALCSW918601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program