Jennifer Rae Henretty, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

25651 Issued in CA

Practice address

9225 Marina Pacifica Dr N
Long Beach, CA 90803-3887

Phone

(562) 714-0504

NPI assigned

Aug 31, 2022

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Dr. Jen Henretty Other name

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": "1661904000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1661904000000",
    "number": "1801516653",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9225 MARINA PACIFICA DR N",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908033887",
            "telephone_number": "562-714-0504"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9225 MARINA PACIFICA DR N",
            "city": "LONG BEACH",
            "state": "CA",
            "postal_code": "908033887",
            "telephone_number": "562-714-0504"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRETTY",
        "first_name": "JENNIFER",
        "middle_name": "RAE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-08-31",
        "last_updated": "2022-08-31",
        "certification_date": "2022-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810005845",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "25651",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JEN",
            "last_name": "HENRETTY",
            "prefix": "DR.",
            "credential": "PHD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Jason Henness
• Elle Hennessee
• Ashlyn Henning, OTD
• Chynel Henning, M.D.
• Callie Henningsen, AMFT
• Henrico V. Mungcal MD
• Andrea Henriquez Ayala, AMFT
• Genesis Henriquez, B.A.
• Hilda Elizabeth Henriquez, MFC 48258
• Henry S. Johnson, M.D.

• Clinical Psychologist in Long Beach, CA
• Providers in Long Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 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.