Provider Demographics
NPI:1164218608
Name:FOSTER, JENA RAE (AMFT, APCC)
Entity type:Individual
Prefix:
First Name:JENA
Middle Name:RAE
Last Name:FOSTER
Suffix:
Gender:F
Credentials:AMFT, APCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1841 W SUNSET BLVD APT 105
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-3236
Mailing Address - Country:US
Mailing Address - Phone:321-704-9522
Mailing Address - Fax:
Practice Address - Street 1:4850 UNION AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-5156
Practice Address - Country:US
Practice Address - Phone:800-913-2615
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-18
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142894103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical