Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Jaqueline Alexis Gorodetsky, PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1619730660

Jaqueline Alexis Gorodetsky, PMHNP is a Nurse Practitioner in Panorama City, California. Qualified in 2023, 3 years ago. Practices as a sole proprietor. Licensed in California.

Years since qualifying
3
Licensed in
CA
In the registry since
2024
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

See every abbreviation used in this directory →

Practice location Address checks out

14860 Roscoe Blvd Ste 307
Panorama City, CA 91402-4691
Phone: (818) 616-2122
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 95027727 (CA)

Record details

NPI number1619730660
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP
Sole proprietorYes
NPI enumeratedFebruary 2, 2024
Last updated in NPPESJanuary 1, 2026
Certification dateJanuary 1, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2023 (3 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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