Provider Demographics
NPI:1073320651
Name:ALTMAN, JAN (PHD)
Entity type:Individual
Prefix:DR
First Name:JAN
Middle Name:
Last Name:ALTMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JANICE
Other - Middle Name:H
Other - Last Name:ALTMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4518 BROMLEY LN # 2
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23221-1102
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5412 GLENSIDE DR STE B
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23228-3995
Practice Address - Country:US
Practice Address - Phone:804-741-4300
Practice Address - Fax:804-741-5300
Is Sole Proprietor?:Yes
Enumeration Date:2024-12-17
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810002590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical