Provider Demographics
NPI:1174607881
Name:ENDELMAN, JANET RUTH (PHD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:RUTH
Last Name:ENDELMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 IRVING ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94122-2599
Mailing Address - Country:US
Mailing Address - Phone:415-731-9344
Mailing Address - Fax:415-731-4390
Practice Address - Street 1:525 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2599
Practice Address - Country:US
Practice Address - Phone:415-731-9344
Practice Address - Fax:415-731-4390
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7076103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPJ007076Medicaid
CAPJ007076Medicaid
CA00PL70760Medicare ID - Type Unspecified