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General NPI Number Information
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NPI Number | 1861508707
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Entity Type | Individual
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Provider Name | JUDITH A. WIENER L.C.S.W., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 30497 CANWOOD ST SUITE 103
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City | AGOURA HILLS
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State | CA
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Zip | 91301-4330
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Country | US
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Telephone | 818-706-0140
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Fax | 818-706-9070
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Provider Business Mailing Address
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Address Line | 74 SMOKE TREE AVE
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City | OAK PARK
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State | CA
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Zip | 91377-1135
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Country | US
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Telephone | 818-515-0481
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Fax | 818-706-9070
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCS 8534
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MFC 15723
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License Number State | CA
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