Provider Demographics
NPI:1588953087
Name:THORPE, JAN CALDWELL (MA, PHD)
Entity type:Individual
Prefix:
First Name:JAN
Middle Name:CALDWELL
Last Name:THORPE
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 SOLANO AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94707-2218
Mailing Address - Country:US
Mailing Address - Phone:510-528-2911
Mailing Address - Fax:
Practice Address - Street 1:1760 SOLANO AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94707-2218
Practice Address - Country:US
Practice Address - Phone:510-528-2911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29733106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist