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General NPI Number Information
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NPI Number | 1134269970
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Entity Type | Individual
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Provider Name | JOHN FRANCIS DERENSKI M.A.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6345 BALBOA BLVD #212
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City | ENCINO
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State | CA
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Zip | 91316-1519
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Country | US
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Telephone | 818-349-5965
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Fax | 818-776-0312
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Provider Business Mailing Address
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Address Line | 6345 BALBOA BLVD #212
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City | ENCINO
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State | CA
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Zip | 91316-1519
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Country | US
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Telephone | 818-349-5965
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Fax | 818-776-0312
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 14575
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License Number State | CA
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