Healthcare Provider Details

I. General information

NPI: 1225192347
Provider Name (Legal Business Name): JANE FRANCES KAHN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 MOUNT LASSEN DR
SAN RAFAEL CA
94903-1112
US

IV. Provider business mailing address

22 MOUNT LASSEN DR
SAN RAFAEL CA
94903-1112
US

V. Phone/Fax

Practice location:
  • Phone: 415-572-8492
  • Fax: 415-334-5712
Mailing address:
  • Phone: 415-572-8492
  • Fax: 415-334-5712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY19486
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: