Provider Demographics
NPI:1780824052
Name:MADONNA, JANET S (MFT)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:S
Last Name:MADONNA
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 1:140 MAYHEW WAY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-4328
Mailing Address - Country:US
Mailing Address - Phone:925-287-9039
Mailing Address - Fax:
Practice Address - Street 1:140 MAYHEW WAY
Practice Address - Street 2:SUITE 301
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-4328
Practice Address - Country:US
Practice Address - Phone:925-287-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC36986106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist