Provider Demographics
NPI:1801076799
Name:STERLING, JEANNE DIANE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEANNE
Middle Name:DIANE
Last Name:STERLING
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1411 MARSH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-2957
Mailing Address - Country:US
Mailing Address - Phone:805-547-1054
Mailing Address - Fax:805-547-1720
Practice Address - Street 1:1411 MARSH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-2957
Practice Address - Country:US
Practice Address - Phone:805-547-1054
Practice Address - Fax:805-547-1720
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-07
Last Update Date:2007-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP17649Medicare PIN