Provider Demographics
NPI:1477576221
Name:DZIWAK, JAMES ANTHONY (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:ANTHONY
Last Name:DZIWAK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:324 CALLE HIGUERA
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010-1729
Mailing Address - Country:US
Mailing Address - Phone:805-402-8340
Mailing Address - Fax:805-384-0371
Practice Address - Street 1:701 E SANTA CLARA ST
Practice Address - Street 2:SUITE 25A
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-5972
Practice Address - Country:US
Practice Address - Phone:805-402-8340
Practice Address - Fax:805-384-0371
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 23447106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist