Organization
FOR FAMILIES, PSYCHOLOGY GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CLARITA WISNIA PH.D (PRESIDENT)
(818) 990-5906
Entity
Organization
Contact information
Practice address
12260 VENTURA BLVD., SUITE LL30, ENCINO, CA 91436
(818) 990-5906
(818) 990-5904
Mailing address
16260 VENTURA BLVD. SUITE LL30, ENCINO, CA 91436
(818) 990-5906
(818) 990-5904
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY13323
CA
1041C0700X
Clinical Social Worker
LCS 22300
CA
Other
Enumeration date
07/05/2013
Last updated
12/03/2013
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