Provider Demographics
NPI:1821661059
Name:DUMITRU, JASON (MS)
Entity type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:DUMITRU
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14719 W MARY CT
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-9677
Mailing Address - Country:US
Mailing Address - Phone:847-322-0518
Mailing Address - Fax:
Practice Address - Street 1:18001 N 79TH AVE STE B20
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8390
Practice Address - Country:US
Practice Address - Phone:847-322-0518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-24
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
AZLMFT-16100106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist