Provider Demographics
NPI:1225227085
Name:WISNIA, CLARITA (PHD)
Entity Type:Individual
Prefix:
First Name:CLARITA
Middle Name:
Last Name:WISNIA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 VENTURA BLVD
Mailing Address - Street 2:SUITE LL30
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4927
Mailing Address - Country:US
Mailing Address - Phone:818-990-5906
Mailing Address - Fax:818-785-6358
Practice Address - Street 1:16260 VENTURA BLVD
Practice Address - Street 2:SUITE LL30
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-4927
Practice Address - Country:US
Practice Address - Phone:818-990-5906
Practice Address - Fax:818-785-6358
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13323103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist