Healthcare Provider Details

I. General information

NPI: 1154638310
Provider Name (Legal Business Name): DORINDA LEE WISEMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2010
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 CORPORATE WAY
SACRAMENTO CA
95831-3875
US

IV. Provider business mailing address

PO BOX 580686
ELK GROVE CA
95758-0012
US

V. Phone/Fax

Practice location:
  • Phone: 916-698-1592
  • Fax: 916-395-4482
Mailing address:
  • Phone: 916-698-1592
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW79460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: