Provider Demographics
NPI:1114909314
Name:MCDONALD, JANE A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:A
Last Name:MCDONALD
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 1:18971 EL MORO WAY
Mailing Address - Street 2:
Mailing Address - City:VILLA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:92861-2241
Mailing Address - Country:US
Mailing Address - Phone:714-637-0191
Mailing Address - Fax:714-283-4805
Practice Address - Street 1:1439 E CHAPMAN AVE
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92866-2228
Practice Address - Country:US
Practice Address - Phone:714-637-0191
Practice Address - Fax:714-283-4805
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACERTIF. PSYCHOANAYST103TP0814X
CALCSW 184381041C0700X
ORLCSW 23651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW184380Medicaid
CALCS18438OtherCA STATE LICENSE
ORLCSW 2365OtherOREGON STATE LLICENSE
CASW18438Medicare ID - Type Unspecified