Provider Demographics
NPI:1447436159
Name:BROOKS, JANE BEAVER (PHD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:BEAVER
Last Name:BROOKS
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 1:2601 COLLEGE AVE APT 112
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3442
Mailing Address - Country:US
Mailing Address - Phone:510-849-3436
Mailing Address - Fax:
Practice Address - Street 1:2601 COLLEGE AVE APT 112
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3442
Practice Address - Country:US
Practice Address - Phone:510-849-3436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-11
Last Update Date:2008-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 2733103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical