Provider Demographics
NPI:1740518588
Name:JEWIK, ANNETTE OI-WAN (LMFT)
Entity type:Individual
Prefix:
First Name:ANNETTE
Middle Name:OI-WAN
Last Name:JEWIK
Suffix:
Gender:F
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:PO BOX 2890
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91793-2890
Mailing Address - Country:US
Mailing Address - Phone:626-392-1382
Mailing Address - Fax:626-962-5368
Practice Address - Street 1:108 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3703
Practice Address - Country:US
Practice Address - Phone:626-281-9280
Practice Address - Fax:626-281-8461
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-04
Last Update Date:2009-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC #31752106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist