Provider Demographics
NPI:1629561444
Name:ELDRIDGE, JANE ANASTATIA (MFT)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:ANASTATIA
Last Name:ELDRIDGE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7777 BODEGA AVE
Mailing Address - Street 2:
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472-3570
Mailing Address - Country:US
Mailing Address - Phone:707-322-1826
Mailing Address - Fax:
Practice Address - Street 1:8297 OLD REDWOOD HWY
Practice Address - Street 2:
Practice Address - City:COTATI
Practice Address - State:CA
Practice Address - Zip Code:94931-5207
Practice Address - Country:US
Practice Address - Phone:707-322-1826
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist