Provider Demographics
NPI:1811243132
Name:FORELO, JANET
Entity type:Individual
Prefix:MISS
First Name:JANET
Middle Name:
Last Name:FORELO
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 1:2037 W BULLARD AVE
Mailing Address - Street 2:PMB 351
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93711-1200
Mailing Address - Country:US
Mailing Address - Phone:559-835-7675
Mailing Address - Fax:
Practice Address - Street 1:45 E SANTA ANA AVE APT 101
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93704-2927
Practice Address - Country:US
Practice Address - Phone:555-206-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
CA807391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1811243132Medicaid