Provider Demographics
NPI:1598100224
Name:BREWER, JANET K (JD, PSYD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:K
Last Name:BREWER
Suffix:
Gender:F
Credentials:JD, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 286
Mailing Address - Street 2:
Mailing Address - City:PAXTON
Mailing Address - State:IL
Mailing Address - Zip Code:60957-0286
Mailing Address - Country:US
Mailing Address - Phone:631-961-6487
Mailing Address - Fax:
Practice Address - Street 1:10880 WILSHIRE BLVD STE 1101
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4112
Practice Address - Country:US
Practice Address - Phone:631-961-6487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-05-08
Last Update Date:2023-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180010245101YM0800X, 225C00000X
CA30790103T00000X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor