Provider Demographics
NPI:1982192357
Name:DRJAYN.COM
Entity type:Organization
Organization Name:DRJAYN.COM
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JAYNTHI
Authorized Official - Middle Name:JAYN
Authorized Official - Last Name:RAJANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSY D
Authorized Official - Phone:510-516-3188
Mailing Address - Street 1:667 LYTTON AVE
Mailing Address - Street 2:SUITE 8
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301-1335
Mailing Address - Country:US
Mailing Address - Phone:510-516-3188
Mailing Address - Fax:
Practice Address - Street 1:5661 KEITH AVE STE 104
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1815
Practice Address - Country:US
Practice Address - Phone:510-516-3188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-01
Last Update Date:2018-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50666106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty