Provider Demographics
NPI:1366466518
Name:FRANCIS, JOAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:
Last Name:FRANCIS
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 12113
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92423-2113
Mailing Address - Country:US
Mailing Address - Phone:909-381-3579
Mailing Address - Fax:909-381-3501
Practice Address - Street 1:1911 COMMERCENTER E STE 101
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92408-3480
Practice Address - Country:US
Practice Address - Phone:909-381-3579
Practice Address - Fax:909-381-3501
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7981103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPH0079810Medicaid
CAPL79810Medicare ID - Type Unspecified