Basic Information
| Provider Information | |||||||||
| NPI: | 1861689937 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BERTOLANI | ||||||||
| FirstName: | JANE | ||||||||
| MiddleName: | |||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8421 AUBURN BLVD | ||||||||
| Address2: | BUILDING #3 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Practice Location | |||||||||
| Address1: | 8421 AUBURN BLVD | ||||||||
| Address2: | BUILDING #3 | ||||||||
| City: | CITRUS HEIGHTS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 956100359 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167226100 | ||||||||
| FaxNumber: | 9167229229 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2007 | ||||||||
| LastUpdateDate: | 10/02/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF54774 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.