Active NPI
Jennifer Fay Mosson
- Licensed Psychiatric Technician
- La Verne, CA
National Provider Identifier
1235492612
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Licensed Psychiatric Technician
- License
- PT34218
- Practice address
- 233 Baseline Rd
La Verne, CA 91750-2353 - Phone
- (909) 593-2581
- Fax
- (909) 596-3567
- NPI assigned
- Jun 20, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Licensed Psychiatric Technician | 167G00000X | PT34218 | CA | Primary |
Addresses
Primary practice location
233 Baseline Rd
La Verne, CA 91750-2353
Mailing address
233 Baseline Rd
La Verne, CA 91750-2353
Phone (909) 593-2581
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 7565A | Other | CA | OUTPATIENT MENTAL HEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PT34218 | CA | MD | Orthopedic Physical Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Leroy Haynes Center | Past | Accepting new patients | |
| Haynes Family of Programs | Past | Accepting new patients |
Organizations & group practices 2
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.
-
- Emotionally Disturbed Childrens' Residential Treatment Facility
- La Verne, CA
- NPI 1467713743
-
- Mental Illness Community Based Residential Treatment Facility
- La Verne, CA
- NPI 1164548236
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1340150400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1340150400000",
"number": "1235492612",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "233 BASELINE RD",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917502353",
"telephone_number": "909-593-2581",
"fax_number": "909-596-3567"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "233 BASELINE RD",
"city": "LA VERNE",
"state": "CA",
"postal_code": "917502353",
"telephone_number": "909-593-2581",
"fax_number": "909-596-3567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSSON",
"first_name": "JENNIFER",
"middle_name": "FAY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-06-20",
"last_updated": "2012-06-20",
"status": "A"
},
"taxonomies": [
{
"code": "167G00000X",
"taxonomy_group": "",
"desc": "Licensed Psychiatric Technician",
"state": "CA",
"license": "PT34218",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OUTPATIENT MENTAL HEALTH",
"identifier": "7565A",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in La Verne, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 20, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.