Provider Demographics
NPI:1649413345
Name:LAVANE, JEAN ELIZABETH (LMFT)
Entity type:Individual
Prefix:MS
First Name:JEAN
Middle Name:ELIZABETH
Last Name:LAVANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 SOLANO AVENUE #7518
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707
Mailing Address - Country:US
Mailing Address - Phone:510-550-2922
Mailing Address - Fax:510-550-2922
Practice Address - Street 1:646 CORNELL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1211
Practice Address - Country:US
Practice Address - Phone:510-550-2922
Practice Address - Fax:510-550-2922
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-09
Last Update Date:2020-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45425106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist