Provider Demographics
NPI:1306852348
Name:MATIJASIC, JANE COOPER (LCSW BCD)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:COOPER
Last Name:MATIJASIC
Suffix:
Gender:F
Credentials:LCSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1303 JEFFERSON ST
Mailing Address - Street 2:SUITE 600A
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94559-2442
Mailing Address - Country:US
Mailing Address - Phone:707-257-1049
Mailing Address - Fax:707-224-2894
Practice Address - Street 1:1303 JEFFERSON ST
Practice Address - Street 2:SUITE 600A
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94559-2442
Practice Address - Country:US
Practice Address - Phone:707-257-1049
Practice Address - Fax:707-224-2894
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2009-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS91401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26189ZMedicare PIN