Active NPI
Jenna Karlsberg Bennett
- Psychologist
- Burbank, CA
National Provider Identifier
1417575499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY34258
- Practice address
- 221 N 3Rd St # 443
Burbank, CA 91502-1202 - Phone
- (424) 253-4656
- NPI assigned
- Jul 7, 2020
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY34258 | CA | Primary |
Addresses
Primary practice location
221 N 3Rd St # 443
Burbank, CA 91502-1202
Mailing address
221 N 3Rd St # 443
Burbank, CA 91502-1202
Phone (424) 253-4656
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jan 3, 2024 through Jan 3, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY34258 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1594080000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1686268800000",
"number": "1417575499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "221 N 3RD ST # 443",
"city": "BURBANK",
"state": "CA",
"postal_code": "915021202",
"telephone_number": "424-253-4656"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "221 N 3RD ST # 443",
"city": "BURBANK",
"state": "CA",
"postal_code": "915021202",
"telephone_number": "424-253-4656"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BENNETT",
"first_name": "JENNA",
"middle_name": "KARLSBERG",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-07-07",
"last_updated": "2023-06-09",
"certification_date": "2023-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY34258",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Burbank, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.