Provider Demographics
NPI:1801859301
Name:DOANE, JERI A (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERI
Middle Name:A
Last Name:DOANE
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 1:3019 WILSHIRE BLVD STE 294
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2301
Mailing Address - Country:US
Mailing Address - Phone:310-883-8696
Mailing Address - Fax:310-826-9345
Practice Address - Street 1:9201 WILSHIRE BLVD STE 207
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5513
Practice Address - Country:US
Practice Address - Phone:310-883-8696
Practice Address - Fax:310-826-9345
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-07
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY057363Medicaid
CAPSY057363Medicaid
CP5736CMedicare ID - Type Unspecified