Provider Demographics
NPI:1598856015
Name:MIZERAK, JONEL (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JONEL
Middle Name:
Last Name:MIZERAK
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JONEL
Other - Middle Name:
Other - Last Name:MIZERAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHYSICAL THERAPIST A
Mailing Address - Street 1:101 GREGORY LN
Mailing Address - Street 2:SUITE 46
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4982
Mailing Address - Country:US
Mailing Address - Phone:925-548-8841
Mailing Address - Fax:925-548-8841
Practice Address - Street 1:101 GREGORY LN
Practice Address - Street 2:SUITE 46
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4982
Practice Address - Country:US
Practice Address - Phone:925-548-8841
Practice Address - Fax:925-548-8841
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAT259225200000X
CAMFC48118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant