Provider Demographics
NPI:1700098860
Name:MENTING, DAWN LASISTER (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:LASISTER
Last Name:MENTING
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 1:256 E GREENHAVEN ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91722-2838
Mailing Address - Country:US
Mailing Address - Phone:949-463-5683
Mailing Address - Fax:
Practice Address - Street 1:532 E ROUTE 66
Practice Address - Street 2:
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-3505
Practice Address - Country:US
Practice Address - Phone:949-463-5683
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS282281041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS28228OtherBOARD OF BEHAVIORAL SCIENCES