Healthcare Provider Details

I. General information

NPI: 1972428183
Provider Name (Legal Business Name): JANE SANCTUARY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2026
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 OLIVE AVE
NOVATO CA
94945-2564
US

IV. Provider business mailing address

1015 7TH ST
NOVATO CA
94945-2205
US

V. Phone/Fax

Practice location:
  • Phone: 415-897-2131
  • Fax:
Mailing address:
  • Phone: 415-897-4201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: