Provider Demographics
NPI:1427196344
Name:WASCO, DENNIS JOSEPH (MA, MFT)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:JOSEPH
Last Name:WASCO
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1653
Mailing Address - Country:US
Mailing Address - Phone:925-852-5280
Mailing Address - Fax:925-757-9024
Practice Address - Street 1:579 MT OLIVET PL
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:CA
Practice Address - Zip Code:94517-1609
Practice Address - Country:US
Practice Address - Phone:925-852-5280
Practice Address - Fax:925-757-9024
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2013-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 50434106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist