Healthcare Provider Details

I. General information

NPI: 1063321370
Provider Name (Legal Business Name): JENNIFER CASTLEBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6550 W 80TH ST
LOS ANGELES CA
90045-1127
US

IV. Provider business mailing address

6550 W 80TH ST
LOS ANGELES CA
90045-1127
US

V. Phone/Fax

Practice location:
  • Phone: 323-307-6746
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number260156230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: