Provider Demographics
NPI:1861508707
Name:WIENER, JUDITH A (LCSW, LMFT)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:A
Last Name:WIENER
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 SMOKE TREE AVE
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-1135
Mailing Address - Country:US
Mailing Address - Phone:818-515-0481
Mailing Address - Fax:818-706-9070
Practice Address - Street 1:30497 CANWOOD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4330
Practice Address - Country:US
Practice Address - Phone:818-706-0140
Practice Address - Fax:818-706-9070
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2013-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 85341041C0700X
CAMFC 15723106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist