Provider Demographics
NPI:1427345677
Name:JONAS, MICHELE W
Entity type:Individual
Prefix:
First Name:MICHELE
Middle Name:W
Last Name:JONAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5267 BOYD AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1025
Mailing Address - Country:US
Mailing Address - Phone:323-371-2767
Mailing Address - Fax:
Practice Address - Street 1:519 17TH ST STE 210
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1568
Practice Address - Country:US
Practice Address - Phone:510-628-9065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-07
Last Update Date:2011-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool