Provider Demographics
NPI:1679909857
Name:DAFOE, JANET (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:
Last Name:DAFOE
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 1:433 KINGSLEY AVE
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-3222
Mailing Address - Country:US
Mailing Address - Phone:650-208-1224
Mailing Address - Fax:650-323-5526
Practice Address - Street 1:433 KINGSLEY AVE
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301-3222
Practice Address - Country:US
Practice Address - Phone:650-208-1224
Practice Address - Fax:650-323-5526
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12007103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent