| Doctor Name: | JENNIFER LISA MADRID |
| NPI Number: | 1578912481 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | PT34767 |
| Business Practice Address: | 574 Formschlag Ln Penngrove, CA - 949518715 |
| Business Phone Number: | 7073222018 |
| Business Fax Number: | |
| Mailing Address: | 574 Formschlag Ln, PENNGROVE |
| State: | CA |
| Postal Code: | 949518715 |
| Phone Number: | 7073222018 |
| Fax Number: | |
| NPI Enumeration Date: | 06/10/2016 |
| NPI Last Update Date: | 06/10/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 167G00000X |
| License Number: | PT34767 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Nursing Service Providers |
| Taxonomy Classification: | Licensed Psychiatric Technician |
| Taxonomy Specialization: | |
| Taxonomy Definition: | An individual licensed by the state board as a Psychiatric Technician based upon completion of a prescribed course of theory and clinical practice, with two thirds of the clinical practice time focused on mental and developmental disorders. The psychiatric technician practices under the direct supervision of a physician, psychologist, registered nurse or other professional to provide care to patients with mental disorders and developmental disabilities. |