Provider Demographics
NPI:1215030101
Name:FIORELLO, JANET LYNNE (PHD)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:LYNNE
Last Name:FIORELLO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17167 FIRST LIGHT LANE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-8709
Mailing Address - Country:US
Mailing Address - Phone:909-816-4165
Mailing Address - Fax:
Practice Address - Street 1:17167 FIRST LIGHT LANE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-8709
Practice Address - Country:US
Practice Address - Phone:909-816-4165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20507103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical