Healthcare Provider Details

I. General information

NPI: 1003100892
Provider Name (Legal Business Name): JANINE R REED M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2011
Last Update Date: 04/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1885 LUNDY AVE 223
SAN JOSE CA
95131-1887
US

IV. Provider business mailing address

777 W MIDDLEFIELD RD APT 65
MOUNTAIN VIEW CA
94043-3302
US

V. Phone/Fax

Practice location:
  • Phone: 408-284-9010
  • Fax:
Mailing address:
  • Phone: 650-862-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF61902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: