Provider Demographics
NPI:1366864332
Name:DUNNE LIZAMA, KILEY (DSW, LMFT)
Entity Type:Individual
Prefix:DR
First Name:KILEY
Middle Name:
Last Name:DUNNE LIZAMA
Suffix:
Gender:F
Credentials:DSW, LMFT
Other - Prefix:
Other - First Name:KILEY
Other - Middle Name:
Other - Last Name:DUNNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 131091
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92013-1091
Mailing Address - Country:US
Mailing Address - Phone:619-841-1044
Mailing Address - Fax:
Practice Address - Street 1:6540 LUSK BLVD.
Practice Address - Street 2:STE C261
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121
Practice Address - Country:US
Practice Address - Phone:619-841-1044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-10
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF78306106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist