Basic Information
| Provider Information | |||||||||
| NPI: | 1114294543 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MEDRANO REYES | ||||||||
| FirstName: | JANET | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW, PPSC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1533 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904043306 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104519747 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1533 EUCLID ST | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90404 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3104519747 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2011 | ||||||||
| LastUpdateDate: | 07/24/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 1041C0700X | LCSW84170 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.