Provider Demographics
NPI:1336437219
Name:WISNIEWSKI, DAWN M (MA, LMFT)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:WISNIEWSKI
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1005 N CENTER AVE APT 3204
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-5597
Mailing Address - Country:US
Mailing Address - Phone:626-622-8319
Mailing Address - Fax:
Practice Address - Street 1:440 E HUNTINGTON DR STE 300
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3775
Practice Address - Country:US
Practice Address - Phone:626-515-4279
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-13
Last Update Date:2021-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF89044106H00000X
CA127901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist