Provider Demographics
NPI:1134269970
Name:DERENSKI, JOHN FRANCIS (MA)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:FRANCIS
Last Name:DERENSKI
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:JOHN
Other - Middle Name:
Other - Last Name:DERENSKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:6345 BALBOA BLVD
Mailing Address - Street 2:#212
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1519
Mailing Address - Country:US
Mailing Address - Phone:818-349-5965
Mailing Address - Fax:818-776-0312
Practice Address - Street 1:6345 BALBOA BLVD
Practice Address - Street 2:#212
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1519
Practice Address - Country:US
Practice Address - Phone:818-349-5965
Practice Address - Fax:818-776-0312
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14575106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist