Provider Demographics
NPI:1912372038
Name:PAONESSA, JANIS M (MA, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:JANIS
Middle Name:M
Last Name:PAONESSA
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 VIRGINIA ST
Mailing Address - Street 2:
Mailing Address - City:RACINE
Mailing Address - State:WI
Mailing Address - Zip Code:53405-1946
Mailing Address - Country:US
Mailing Address - Phone:262-633-8078
Mailing Address - Fax:262-633-8078
Practice Address - Street 1:1 1/2 W GENEVA ST
Practice Address - Street 2:
Practice Address - City:ELKHORN
Practice Address - State:WI
Practice Address - Zip Code:53121-1722
Practice Address - Country:US
Practice Address - Phone:262-734-3424
Practice Address - Fax:262-723-8308
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI1003-124106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist