Provider Demographics
NPI:1043053747
Name:MASONIS, JENNIFER DAWN (CADC II ICADC A06436)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:DAWN
Last Name:MASONIS
Suffix:
Gender:F
Credentials:CADC II ICADC A06436
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:DAWN
Other - Last Name:BALLINGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10989 BLUFFSIDE DR APT 3104
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4406
Mailing Address - Country:US
Mailing Address - Phone:951-834-8808
Mailing Address - Fax:
Practice Address - Street 1:10989 BLUFFSIDE DR APT 3104
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-4406
Practice Address - Country:US
Practice Address - Phone:951-834-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-18
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)