Healthcare Provider Details

I. General information

NPI: 1952650038
Provider Name (Legal Business Name): JENNIFER ABIGAIL DERGREGORIAN PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 W ALAMEDA AVE STE 300
BURBANK CA
91505-4153
US

IV. Provider business mailing address

4100 W ALAMEDA AVE STE 300
BURBANK CA
91505-4153
US

V. Phone/Fax

Practice location:
  • Phone: 999-999-9999
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number26841
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: