Provider Demographics
NPI:1104958321
Name:NAKAGAWA, JANICE Y (PHD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:Y
Last Name:NAKAGAWA
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 1:1409 28TH ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6422
Mailing Address - Country:US
Mailing Address - Phone:916-452-3756
Mailing Address - Fax:916-452-3757
Practice Address - Street 1:1409 28TH ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6422
Practice Address - Country:US
Practice Address - Phone:916-452-3756
Practice Address - Fax:916-452-3757
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7776103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic