Provider Demographics
NPI:1457337925
Name:MEISELMAN, JANET L (PSYD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:MEISELMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1137 PALOMA AVE APT E
Mailing Address - Street 2:
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3588
Mailing Address - Country:US
Mailing Address - Phone:650-288-8810
Mailing Address - Fax:
Practice Address - Street 1:1137 PALOMA AVE APT E
Practice Address - Street 2:
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3588
Practice Address - Country:US
Practice Address - Phone:650-288-8810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22999103G00000X
CT2623103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT680001725Medicare ID - Type Unspecified