Provider Demographics
NPI:1790419315
Name:DOOLAN, JANINE ELISE
Entity Type:Individual
Prefix:
First Name:JANINE
Middle Name:ELISE
Last Name:DOOLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JANINE
Other - Middle Name:ELISE
Other - Last Name:CANAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1925 OVERLAND AVE APT 202
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5892
Mailing Address - Country:US
Mailing Address - Phone:310-498-4984
Mailing Address - Fax:
Practice Address - Street 1:1925 OVERLAND AVE APT 202
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5892
Practice Address - Country:US
Practice Address - Phone:310-498-4984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2022-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA122685106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist