Provider Demographics
NPI:1669789210
Name:HADDOW, JANE (MFT)
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:HADDOW
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1404
Mailing Address - Street 2:
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-2901
Mailing Address - Country:US
Mailing Address - Phone:650-465-3248
Mailing Address - Fax:
Practice Address - Street 1:1061 EL MONTE AVE
Practice Address - Street 2:SUITE A3
Practice Address - City:MOUNTAIN VIEW
Practice Address - State:CA
Practice Address - Zip Code:94040-2336
Practice Address - Country:US
Practice Address - Phone:650-465-3248
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-02
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48519106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist