Provider Demographics
NPI:1003303652
Name:DWORSKY, HARLAN PAUL (MFT)
Entity Type:Individual
Prefix:MR
First Name:HARLAN
Middle Name:PAUL
Last Name:DWORSKY
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21208 COSTANSO ST
Mailing Address - Street 2:#3
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-2060
Mailing Address - Country:US
Mailing Address - Phone:818-346-5188
Mailing Address - Fax:
Practice Address - Street 1:21208 COSTANSO ST
Practice Address - Street 2:#3
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2060
Practice Address - Country:US
Practice Address - Phone:818-346-5188
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21353106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist