Provider Demographics
NPI:1457664930
Name:WINGFIELD, DENNIS EARL (CAS1)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:EARL
Last Name:WINGFIELD
Suffix:
Gender:M
Credentials:CAS1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:944 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4228
Mailing Address - Country:US
Mailing Address - Phone:562-436-3533
Mailing Address - Fax:562-436-0043
Practice Address - Street 1:1529 E PALMDALE BLVD STE 150
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-2038
Practice Address - Country:US
Practice Address - Phone:661-575-1800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-26
Last Update Date:2023-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC13811214101YA0400X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7006Medicaid