Provider Demographics
NPI:1568565539
Name:WIELSTEIN, LESTER HOWARD (CCSW)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:HOWARD
Last Name:WIELSTEIN
Suffix:
Gender:M
Credentials:CCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5150 SUNRISE BLVD STE G5G6
Mailing Address - Street 2:
Mailing Address - City:FAIR OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:95628-4939
Mailing Address - Country:US
Mailing Address - Phone:916-607-6108
Mailing Address - Fax:916-638-1734
Practice Address - Street 1:5150 SUNRISE BLVD STE G5G6
Practice Address - Street 2:
Practice Address - City:FAIR OAKS
Practice Address - State:CA
Practice Address - Zip Code:95628-4939
Practice Address - Country:US
Practice Address - Phone:916-607-6108
Practice Address - Fax:916-638-1734
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2020-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS11320104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker