Provider Demographics
NPI:1063456044
Name:DE JOHNETTE, RETHA MARIA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:RETHA
Middle Name:MARIA
Last Name:DE JOHNETTE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:RETHA
Other - Middle Name:MARIA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:636 ROYCE ST
Mailing Address - Street 2:
Mailing Address - City:ALTADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91001-5219
Mailing Address - Country:US
Mailing Address - Phone:626-695-9885
Mailing Address - Fax:
Practice Address - Street 1:636 ROYCE ST
Practice Address - Street 2:
Practice Address - City:ALTADENA
Practice Address - State:CA
Practice Address - Zip Code:91001-5219
Practice Address - Country:US
Practice Address - Phone:626-695-9885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 223581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical