Provider Demographics
NPI:1871053827
Name:MINICHIELLO, JANET (LCPAT)
Entity type:Individual
Prefix:MS
First Name:JANET
Middle Name:
Last Name:MINICHIELLO
Suffix:
Gender:F
Credentials:LCPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 CARROLL ST NW APT 562
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20012-2093
Mailing Address - Country:US
Mailing Address - Phone:202-431-3990
Mailing Address - Fax:
Practice Address - Street 1:7000 CARROLL AVE STE 200B
Practice Address - Street 2:
Practice Address - City:TAKOMA PARK
Practice Address - State:MD
Practice Address - Zip Code:20912-4437
Practice Address - Country:US
Practice Address - Phone:202-455-5679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-24
Last Update Date:2024-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDATC214221700000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist