Provider Demographics
NPI:1184941775
Name:KIJAK, ADRIENNE KWAPIEN (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:KWAPIEN
Last Name:KIJAK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:846 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3616
Mailing Address - Country:US
Mailing Address - Phone:818-468-9198
Mailing Address - Fax:213-341-5036
Practice Address - Street 1:219 N INDIAN HILL BLVD
Practice Address - Street 2:SUITE 202A
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4644
Practice Address - Country:US
Practice Address - Phone:818-468-9198
Practice Address - Fax:818-468-9198
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-22
Last Update Date:2010-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILART THERAPIST: 05640101Y00000X
CA24579104100000X
IL149-00-5134104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor