Provider Demographics
NPI:1538896725
Name:JAVINE, JOSEPHINE PAIGE (MA AMFT)
Entity type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:PAIGE
Last Name:JAVINE
Suffix:
Gender:F
Credentials:MA AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:178 ECHO AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-4732
Mailing Address - Country:US
Mailing Address - Phone:805-441-4706
Mailing Address - Fax:
Practice Address - Street 1:441 N CENTRAL AVE STE 6
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1428
Practice Address - Country:US
Practice Address - Phone:408-628-0532
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-07
Last Update Date:2022-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122755101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty