Jenna Khoury Mogannam, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

33668 Issued in CA

Practice address

116 E 25TH Ave Ste C
San Mateo, CA 94403-2596

Phone

(415) 238-8513

NPI assigned

Oct 27, 2022

Last updated

Oct 27, 2022By the provider in NPPES

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

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

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

{
    "created_epoch": "1666828800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1666828800000",
    "number": "1215644463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "116 E 25TH AVE STE C",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032596"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "116 E 25TH AVE STE C",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944032596",
            "telephone_number": "415-238-8513"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOGANNAM",
        "first_name": "JENNA",
        "middle_name": "KHOURY",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-27",
        "last_updated": "2022-10-27",
        "certification_date": "2022-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "33668",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "bapfs.com",
            "affiliation": "N",
            "address_1": "116 E 25th Ave Ste C",
            "city": "San Mateo",
            "state": "CA",
            "country_code": "US",
            "postal_code": "944032596",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Clinical Psychologist in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2022; 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.