Provider Demographics
NPI:1467573378
Name:BERESFORD, JANE CLARE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANE
Middle Name:CLARE
Last Name:BERESFORD
Suffix:
Gender:F
Credentials:PSYD
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Other - First Name:
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Mailing Address - Street 1:15300 VENTURA BLVD
Mailing Address - Street 2:#301
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3103
Mailing Address - Country:US
Mailing Address - Phone:310-551-8535
Mailing Address - Fax:818-508-8594
Practice Address - Street 1:15300 VENTURA BLVD
Practice Address - Street 2:#301
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3103
Practice Address - Country:US
Practice Address - Phone:310-551-8535
Practice Address - Fax:818-508-8594
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-02
Last Update Date:2015-11-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 16618103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY 16618OtherPSYCHOLOGY LICENSE