Provider Demographics
NPI:1295076578
Name:MEDNICK, JOANNE GAIL (MFT)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:GAIL
Last Name:MEDNICK
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 1:881 ALMA REAL DR STE 218
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-5039
Mailing Address - Country:US
Mailing Address - Phone:310-310-9249
Mailing Address - Fax:
Practice Address - Street 1:881 ALMA REAL DR STE 218
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-5039
Practice Address - Country:US
Practice Address - Phone:310-310-9249
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-11
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 36644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist