Provider Demographics
NPI:1194915736
Name:MADANI, JENNIFER J (PSYD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:J
Last Name:MADANI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39420 LIBERTY ST STE 140
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2289
Mailing Address - Country:US
Mailing Address - Phone:415-516-8964
Mailing Address - Fax:
Practice Address - Street 1:39420 LIBERTY ST STE 140
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2289
Practice Address - Country:US
Practice Address - Phone:510-464-4534
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23735103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist