Provider Demographics
NPI:1568763563
Name:PLATANIA, JON V (PHD)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:V
Last Name:PLATANIA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:JON
Other - Middle Name:V
Other - Last Name:PLATANIA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1385 SHATTUCK AVE
Mailing Address - Street 2:302
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-1481
Mailing Address - Country:US
Mailing Address - Phone:510-841-4668
Mailing Address - Fax:510-548-0313
Practice Address - Street 1:1385 SHATTUCK AVE
Practice Address - Street 2:302
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-1481
Practice Address - Country:US
Practice Address - Phone:510-841-4668
Practice Address - Fax:510-843-0202
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-06
Last Update Date:2015-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSYCH 13269103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist