Healthcare Provider Details

I. General information

NPI: 1053788448
Provider Name (Legal Business Name): JOSEPH M DZIERZEWSKI PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 09/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16111 PLUMMER ST 11E
NORTH HILLS CA
91343-2036
US

IV. Provider business mailing address

16111 PLUMMER ST 11E
NORTH HILLS CA
91343-2036
US

V. Phone/Fax

Practice location:
  • Phone: 818-891-7711
  • Fax:
Mailing address:
  • Phone: 818-891-7711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number0810005189
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: