Jenna Mattingly, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-10-7681

Practice address

2807 Elm Ave
Manhattan Beach, CA 90266-2427

Phone

(323) 649-0865

NPI assigned

Jun 18, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Iska Inc

  • Developmentally Disabled Services Day Training Agency
  • St Louis, MN
  • NPI 1053772939
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1631491200000",
    "number": "1205199080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2807 ELM AVE",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662427"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2807 ELM AVE",
            "city": "MANHATTAN BEACH",
            "state": "CA",
            "postal_code": "902662427",
            "telephone_number": "323-649-0865"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6059 Bristol Pkwy",
            "address_2": "#100",
            "address_purpose": "LOCATION",
            "city": "Culver City",
            "state": "CA",
            "postal_code": "902306663",
            "country_code": "US",
            "telephone_number": "866-278-1520",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "4236 park Glen Rd",
            "address_purpose": "LOCATION",
            "city": "St Louis",
            "state": "MN",
            "postal_code": "55416",
            "country_code": "US",
            "telephone_number": "612-636-7188",
            "fax_number": "612-605-3312",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MATTINGLY",
        "first_name": "JENNA",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2021-09-13",
        "certification_date": "2021-09-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-10-7681",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christian Mata
• Rincy Mathew, LMFT
• Marcia Matika, DPM
• Matin Medicine, Inc.
• Christina Birgitta Matso, PH.D. , MFT
• Valerie L Maxwell, PH.D.
• Maty Mazal, PH.D
• Andrea McCann, MFT
• Timothy P McCauley, MSPT
• Courtland McCoy, DC

• Behavior Analyst in Manhattan Beach, CA
• Providers in Manhattan Beach, CA by specialty
• Behavior Analyst in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.