Provider Demographics
NPI:1114045945
Name:JAMESON, JULIANNE DONNER (PHD)
Entity Type:Individual
Prefix:
First Name:JULIANNE
Middle Name:DONNER
Last Name:JAMESON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 TERRADO PLAZA
Mailing Address - Street 2:#40
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723
Mailing Address - Country:US
Mailing Address - Phone:626-332-0556
Mailing Address - Fax:626-332-6587
Practice Address - Street 1:750 TERRADO PLZ
Practice Address - Street 2:#49
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3419
Practice Address - Country:US
Practice Address - Phone:626-201-6643
Practice Address - Fax:626-967-3015
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8547103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CP8547Medicare ID - Type Unspecified