Provider Demographics
NPI:1134356264
Name:SINCLAIR, JANE AGNES (MFT, MSN)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:AGNES
Last Name:SINCLAIR
Suffix:
Gender:F
Credentials:MFT, MSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:3420 KENYON ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-5001
Mailing Address - Country:US
Mailing Address - Phone:619-221-6591
Mailing Address - Fax:619-221-6556
Practice Address - Street 1:3420 KENYON ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-5001
Practice Address - Country:US
Practice Address - Phone:619-221-6591
Practice Address - Fax:619-221-6556
Is Sole Proprietor?:No
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12952101YA0400X
CA253569101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)