MEDICARE: JENNIFER KATHERINE FORSYTH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	31105	CA

General Provider Information

NPI Number	:	1548517212
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER KATHERINE FORSYTH

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD SUITE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-5631
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:	310-301-8751

Provider Business Practice Location Address
First Line	:	300 UCLA MEDICAL PLZ STE 2200
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-2004
Country	:	US
Telephone Number	:	310-825-9989
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	11/19/2020

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