Provider Demographics
NPI:1891282968
Name:VAN ZANEN, JAMIE LYNN (LCSW)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:LYNN
Last Name:VAN ZANEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:373 AVENIDA MANZANOS
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-1413
Mailing Address - Country:US
Mailing Address - Phone:408-827-8865
Mailing Address - Fax:
Practice Address - Street 1:46 N 2ND ST
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-2026
Practice Address - Country:US
Practice Address - Phone:408-827-8865
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-15
Last Update Date:2023-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61669101YM0800X
CALCSW61669101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health