Provider Demographics
NPI:1235904111
Name:CASILLAS, JANNA MARIA (PSYD)
Entity type:Individual
Prefix:DR
First Name:JANNA
Middle Name:MARIA
Last Name:CASILLAS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:JANNA
Other - Middle Name:MARIA
Other - Last Name:SCHIRMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:262 N LOS ROBLES AVE APT 114
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1534
Mailing Address - Country:US
Mailing Address - Phone:817-863-1085
Mailing Address - Fax:
Practice Address - Street 1:16465 SIERRA LAKES PKWY STE 140
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-1242
Practice Address - Country:US
Practice Address - Phone:909-244-9593
Practice Address - Fax:833-903-0337
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-20
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34680103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist