Healthcare Provider Details

I. General information

NPI: 1083526446
Provider Name (Legal Business Name): DAWN R PREDIUM LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21370 HOMESTEAD RD
CUPERTINO CA
95014-0292
US

IV. Provider business mailing address

21370 HOMESTEAD RD
CUPERTINO CA
95014-0292
US

V. Phone/Fax

Practice location:
  • Phone: 408-522-2558
  • Fax: 408-738-8631
Mailing address:
  • Phone: 408-522-2558
  • Fax: 408-738-8631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: