Provider Demographics
NPI:1467887083
Name:SIA-FLAHERTY, JANE ALTAVAS (LCSW)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:ALTAVAS
Last Name:SIA-FLAHERTY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ALTAVAS
Other - Last Name:SIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3288 ADAMS AVE UNIT 16773
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92176-7032
Mailing Address - Country:US
Mailing Address - Phone:619-259-0507
Mailing Address - Fax:
Practice Address - Street 1:2855 TELEGRAPH AVE STE 515
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1151
Practice Address - Country:US
Practice Address - Phone:510-764-3787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-13
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW 66918101YM0800X
CA1014YA0400X1041C0700X
CA1024831041C0700X
CALCSW1024831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1014YA0400XMedicaid