Provider Demographics
NPI:1144554593
Name:DELEHANTY, JANE MAUREEN (MFT, OTR/L, PPS)
Entity type:Individual
Prefix:MS
First Name:JANE
Middle Name:MAUREEN
Last Name:DELEHANTY
Suffix:
Gender:F
Credentials:MFT, OTR/L, PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29614 WENGLER HILL RD
Mailing Address - Street 2:
Mailing Address - City:SHINGLETOWN
Mailing Address - State:CA
Mailing Address - Zip Code:96088-9665
Mailing Address - Country:US
Mailing Address - Phone:530-474-5809
Mailing Address - Fax:530-474-3766
Practice Address - Street 1:29614 WENGLER HILL RD.
Practice Address - Street 2:
Practice Address - City:SHINGLETOWN
Practice Address - State:CA
Practice Address - Zip Code:96088
Practice Address - Country:US
Practice Address - Phone:530-241-7882
Practice Address - Fax:530-474-3766
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36742106H00000X
CADOCUMENT#040085151101YS0200X
CAAMTA # 1117225700000X
CAOT6419225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist