Provider Demographics
NPI:1154587582
Name:JANOSIK, DONNA (LMFT)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:JANOSIK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1136 FREMONT AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3249
Mailing Address - Country:US
Mailing Address - Phone:310-570-7342
Mailing Address - Fax:
Practice Address - Street 1:1136 FREMONT AVE STE 101
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3249
Practice Address - Country:US
Practice Address - Phone:310-570-7342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-05
Last Update Date:2019-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC45256106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist