Jennifer Jane Ballerini, PSY.D.
Individual provider Active NPI Clinical Psychologist · Fair Oaks, CA
NPI 1093966053 · NPPES record last updated May 27, 2009
Key facts
- NPI
- 1093966053
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY22155 (CA)
- Practice address
- 8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759 - Phone
- (916) 276-7709
- Fax
- (916) 534-7753
- NPI assigned
- Oct 8, 2008
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
- Opted out of Medicare
- Yes, effective Oct 23, 2019 through Oct 23, 2027
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY22155 | CA | MD | Clinical Psychologist |
| 22155 | CA | MD | Speech-Language Pathologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY22155 | CA | Yes |
Addresses
Primary practice location
8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759
Mailing address
8080 Madison Ave
Ste 200 D
Fair Oaks, CA 95628-3759
Phone (916) 276-7709
Other providers in Fair Oaks, CA
- Bainer Chiropractic Inc.
- Mark Charles Bainer
- Jaswinder Pal Singh Bajwa
- Michael Baker
- Jagayra Balderas
- Christopher D.H. Bambus
- Cesar Antonio Banda
- Kehinde Paul Bankole
- Katie Arlene Baptist
- William L Bargar
All providers in Fair Oaks, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 27, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Opt Out Affidavits (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.