Provider Demographics
NPI:1588798573
Name:KINCAID, JENNIFER ANN (MS)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:KINCAID
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4001 LONG BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-2616
Mailing Address - Country:US
Mailing Address - Phone:562-427-7671
Mailing Address - Fax:
Practice Address - Street 1:6237 SURFLANDING LN
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-7510
Practice Address - Country:US
Practice Address - Phone:714-960-5606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist