Healthcare Provider Details

I. General information

NPI: 1568680072
Provider Name (Legal Business Name): JANE MARIE ZICH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1036 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1427
US

IV. Provider business mailing address

1036 SIR FRANCIS DRAKE BLVD
KENTFIELD CA
94904-1427
US

V. Phone/Fax

Practice location:
  • Phone: 415-752-8022
  • Fax:
Mailing address:
  • Phone: 415-752-8022
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 8675
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 8675
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: