Provider Demographics
NPI:1922028448
Name:MAGNER, JANICE DEE (MFT)
Entity Type:Individual
Prefix:
First Name:JANICE
Middle Name:DEE
Last Name:MAGNER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 DUNDEE WAY
Mailing Address - Street 2:
Mailing Address - City:BENICIA
Mailing Address - State:CA
Mailing Address - Zip Code:94510-1901
Mailing Address - Country:US
Mailing Address - Phone:707-745-4519
Mailing Address - Fax:707-747-9228
Practice Address - Street 1:203 DUNDEE WAY
Practice Address - Street 2:
Practice Address - City:BENICIA
Practice Address - State:CA
Practice Address - Zip Code:94510-1901
Practice Address - Country:US
Practice Address - Phone:707-745-4519
Practice Address - Fax:707-747-9228
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMPO22329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist