Provider Demographics
NPI:1497819825
Name:STREET, JANELLA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANELLA
Middle Name:
Last Name:STREET
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JANELLA
Other - Middle Name:STREET
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1061 EASTSHORE HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94710-1006
Mailing Address - Country:US
Mailing Address - Phone:510-847-7452
Mailing Address - Fax:510-327-0326
Practice Address - Street 1:1061 EASTSHORE HWY STE 203
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94710-1006
Practice Address - Country:US
Practice Address - Phone:510-847-7452
Practice Address - Fax:510-327-0326
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20439103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical