Provider Demographics
NPI:1013068550
Name:LORRAINE, JANET (MFT)
Entity Type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:LORRAINE
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 1:2003 BURBANK AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-7116
Mailing Address - Country:US
Mailing Address - Phone:707-542-0182
Mailing Address - Fax:
Practice Address - Street 1:2003 BURBANK AVE
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-7116
Practice Address - Country:US
Practice Address - Phone:707-542-0182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20288170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS