Provider Demographics
NPI:1457952848
Name:JANOSKE, JENA
Entity Type:Individual
Prefix:
First Name:JENA
Middle Name:
Last Name:JANOSKE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 MILL ST FL 1
Mailing Address - Street 2:
Mailing Address - City:LAVALE
Mailing Address - State:MD
Mailing Address - Zip Code:21502-7055
Mailing Address - Country:US
Mailing Address - Phone:866-287-0362
Mailing Address - Fax:
Practice Address - Street 1:8865 NORWIN AVE STE 27123
Practice Address - Street 2:
Practice Address - City:NORTH HUNTINGDON
Practice Address - State:PA
Practice Address - Zip Code:15642-2769
Practice Address - Country:US
Practice Address - Phone:866-287-0362
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-03
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician