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General NPI Number Information
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NPI Number | 1174987630
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Entity Type | Organization
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Legal Business Name | BARBARA L. JANETZKE, PHD
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Dates
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Enumeration Date | 04/11/2016
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Last Update Date | 04/11/2016
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Provider Practice Location Address
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Address Line | 2400 MISSION ST
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City | SAN MARINO
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State | CA
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Zip | 91108-1632
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Country | US
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Telephone | 626-255-7512
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Fax |
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Provider Business Mailing Address
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Address Line | 2400 MISSION ST
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City | SAN MARINO
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State | CA
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Zip | 91108-1632
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Country | US
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Telephone | 626-255-7512
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Fax |
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST
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Name | DR. BARBARA L JANETZKE
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Credential | PH.D.
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Telephone | 626-255-7512
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY20188
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License Number State | CA
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