Provider Demographics
NPI:1780676924
Name:FISKE-GENEST, JANIS L (LCSW)
Entity type:Individual
Prefix:MS
First Name:JANIS
Middle Name:L
Last Name:FISKE-GENEST
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:JANIS
Other - Middle Name:LYNN
Other - Last Name:FISKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2021 WILLOWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3132
Mailing Address - Country:US
Mailing Address - Phone:760-725-5020
Mailing Address - Fax:
Practice Address - Street 1:2021 WILLOWOOD LN
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3132
Practice Address - Country:US
Practice Address - Phone:760-725-5020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS203261041C0700X
OR16091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR1609OtherSTATE LICENSE
CALCS20326OtherSTATE LICENSE