Provider Demographics
NPI:1871816132
Name:GANESH, JAN (PSY D)
Entity Type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:GANESH
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 E BOYNTON BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3839
Mailing Address - Country:US
Mailing Address - Phone:561-732-3236
Mailing Address - Fax:561-732-6849
Practice Address - Street 1:211 E BOYNTON BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3839
Practice Address - Country:US
Practice Address - Phone:561-732-3236
Practice Address - Fax:561-732-6849
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-01
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY7079174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist