Provider Demographics
NPI:1841523768
Name:SAMSTAG, JENNIFER BROOKE (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:BROOKE
Last Name:SAMSTAG
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 1:5850 CANOGA AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6554
Mailing Address - Country:US
Mailing Address - Phone:626-385-7793
Mailing Address - Fax:
Practice Address - Street 1:5850 CANOGA AVE STE 400
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6554
Practice Address - Country:US
Practice Address - Phone:626-385-7793
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-09
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26050103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical