1912372038 NPI number — MRS. JANIS M PAONESSA M.A., LMFT

Table of content: MRS. JANIS M PAONESSA M.A., LMFT (NPI 1912372038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912372038 NPI number — MRS. JANIS M PAONESSA M.A., LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAONESSA
Provider First Name:
JANIS
Provider Middle Name:
M
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1912372038
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 VIRGINIA ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RACINE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
53405-1946
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
262-633-8078
Provider Business Mailing Address Fax Number:
262-633-8078

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 1/2 W GENEVA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELKHORN
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
53121-1722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
262-734-3424
Provider Business Practice Location Address Fax Number:
262-723-8308
Provider Enumeration Date:
12/01/2015

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  1003-124 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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