Provider Demographics
NPI:1356413181
Name:ALEXANDER, JEANNE LOUISE LEVENTHAL (MD)
Entity type:Individual
Prefix:MS
First Name:JEANNE
Middle Name:LOUISE LEVENTHAL
Last Name:ALEXANDER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:JEANNE
Other - Middle Name:LOUISE
Other - Last Name:LEVENTHAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2930 DOMINGO AVENUE, #304
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94705
Mailing Address - Country:US
Mailing Address - Phone:510-845-9005
Mailing Address - Fax:510-981-2231
Practice Address - Street 1:2920 DOMINGO AVENUE, SUITE 204D
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705
Practice Address - Country:US
Practice Address - Phone:510-845-9005
Practice Address - Fax:510-981-2231
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG520602084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G520600Medicaid
CA00G520600Medicaid
00G520600Medicare ID - Type Unspecified