Provider Demographics
NPI:1417192733
Name:DASHEVSKY, IRENE V
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:V
Last Name:DASHEVSKY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIMA
Other - Middle Name:
Other - Last Name:DASHEVSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMFT
Mailing Address - Street 1:1266 14TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2205
Mailing Address - Country:US
Mailing Address - Phone:510-368-4010
Mailing Address - Fax:510-530-8083
Practice Address - Street 1:1266 14TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2205
Practice Address - Country:US
Practice Address - Phone:510-368-4010
Practice Address - Fax:510-530-8083
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-16
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82579106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist