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General NPI Number Information
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NPI Number | 1194915736
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Entity Type | Individual
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Provider Name | JENNIFER J MADANI PSYD
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Gender | Female
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Dates
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Enumeration Date | 07/30/2007
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 39420 LIBERTY ST STE 140
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City | FREMONT
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State | CA
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Zip | 94538-2289
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Country | US
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Telephone | 510-464-4534
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Fax |
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Provider Business Mailing Address
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Address Line | 39420 LIBERTY ST STE 140
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City | FREMONT
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State | CA
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Zip | 94538-2289
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Country | US
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Telephone | 415-516-8964
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY23735
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License Number State | CA
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