Provider Demographics
NPI:1861554032
Name:CHARLES, JANET JAY (IMF)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:JAY
Last Name:CHARLES
Suffix:
Gender:F
Credentials:IMF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1541 LONDON CIR
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1337
Mailing Address - Country:US
Mailing Address - Phone:707-553-5574
Mailing Address - Fax:707-553-5719
Practice Address - Street 1:146 RAINIER AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94589-1846
Practice Address - Country:US
Practice Address - Phone:707-553-5574
Practice Address - Fax:707-553-5719
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF51025106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist