Healthcare Provider Details

I. General information

NPI: 1083199459
Provider Name (Legal Business Name): ELIZABETH ZAMIEROWSKI WENGER MA, LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2018
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 QUAIL ST STE 245
NEWPORT BEACH CA
92660-2749
US

IV. Provider business mailing address

1000 QUAIL ST STE 245
NEWPORT BEACH CA
92660-2749
US

V. Phone/Fax

Practice location:
  • Phone: 949-229-2224
  • Fax:
Mailing address:
  • Phone: 949-229-2224
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number10844
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number108544
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: