Provider Demographics
NPI:1083199459
Name:WENGER, ELIZABETH ZAMIEROWSKI (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:ZAMIEROWSKI
Last Name:WENGER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CONGRESS STREET
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3337
Mailing Address - Country:US
Mailing Address - Phone:949-229-2224
Mailing Address - Fax:
Practice Address - Street 1:1001 DOVE ST STE 280
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2815
Practice Address - Country:US
Practice Address - Phone:929-923-8961
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10844106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist