Provider Demographics
NPI:1639280076
Name:KRAEMER, JANET ELLEN (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:ELLEN
Last Name:KRAEMER
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 1:13980 BLOSSOM HILL RD
Mailing Address - Street 2:STE B
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5121
Mailing Address - Country:US
Mailing Address - Phone:408-231-0829
Mailing Address - Fax:
Practice Address - Street 1:13980 BLOSSOM HILL RD
Practice Address - Street 2:STE B
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5121
Practice Address - Country:US
Practice Address - Phone:408-231-0829
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14161103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2782634Medicaid
CAR92978Medicare UPIN
CA2782634Medicaid