| Doctor Name: | DR. JENNIE M. MATHESS |
| NPI Number: | 1003035304 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PSY.D. |
| License Number: | PSY21405 |
| Business Practice Address: | 840 N Avenue 66 Los Angeles, CA - 900421508 |
| Business Phone Number: | 6263957100 |
| Business Fax Number: | |
| Mailing Address: | 840 N Avenue 66, LOS ANGELES |
| State: | CA |
| Postal Code: | 900421508 |
| Phone Number: | 6263957100 |
| Fax Number: | |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 10/03/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY21405 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |