Provider Demographics
NPI:1023249372
Name:PESSO, DAWN ALICIA (MFT)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:ALICIA
Last Name:PESSO
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:ALICIA
Other - Last Name:OLUFSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:9451 CORBIN AVE.
Mailing Address - Street 2:STE. #100
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91324
Mailing Address - Country:US
Mailing Address - Phone:800-321-2843
Mailing Address - Fax:818-704-4252
Practice Address - Street 1:10436 SANTA MONICA BLVD.
Practice Address - Street 2:STE. #3030
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-470-9630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2017-01-26
Deactivation Date:2012-06-13
Deactivation Code:
Reactivation Date:2017-01-26
Provider Licenses
StateLicense IDTaxonomies
CAMFC45142106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist