Provider Demographics
NPI:1306738141
Name:POPPY, JENNIFER FAYE (RADT)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:FAYE
Last Name:POPPY
Suffix:
Gender:F
Credentials:RADT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2515 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:CARSON
Mailing Address - State:CA
Mailing Address - Zip Code:90810-1519
Mailing Address - Country:US
Mailing Address - Phone:951-235-9015
Mailing Address - Fax:
Practice Address - Street 1:2515 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90810-1519
Practice Address - Country:US
Practice Address - Phone:951-235-9015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR1419580725101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)