Provider Demographics
NPI:1720258411
Name:TAYLOR, JANICE C (MA EDS PHD)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:C
Last Name:TAYLOR
Suffix:
Gender:F
Credentials:MA EDS PHD
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 1693
Mailing Address - Street 2:
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25402
Mailing Address - Country:US
Mailing Address - Phone:304-274-2512
Mailing Address - Fax:
Practice Address - Street 1:110 MORDINGTON AVENUE
Practice Address - Street 2:JEFFERSON COUNTY BOARD OF EDUCATION
Practice Address - City:CHARLES TOWN
Practice Address - State:WV
Practice Address - Zip Code:25414
Practice Address - Country:US
Practice Address - Phone:304-725-9741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1796103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166283000Medicaid