Provider Demographics
NPI:1184663916
Name:KAPLAN, JO ANNE (PHD)
Entity Type:Individual
Prefix:
First Name:JO ANNE
Middle Name:
Last Name:KAPLAN
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:PO BOX 16731
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6731
Mailing Address - Country:US
Mailing Address - Phone:818-571-6210
Mailing Address - Fax:
Practice Address - Street 1:18401 BURBANK BLVD
Practice Address - Street 2:#118
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2822
Practice Address - Country:US
Practice Address - Phone:818-571-6210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2009-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY171260103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA18799Medicaid
CA939595OtherQME
CAP32460Medicare UPIN
CA939595OtherQME