Provider Demographics
NPI:1104698364
Name:DZIEMIDOK, LUKAS (MS, LMFT)
Entity type:Individual
Prefix:
First Name:LUKAS
Middle Name:
Last Name:DZIEMIDOK
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:LUKASZ
Other - Middle Name:PIOTR
Other - Last Name:DZIEMIDOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12605 VENTURA BLVD # 1078
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-2415
Mailing Address - Country:US
Mailing Address - Phone:747-356-8388
Mailing Address - Fax:323-381-5958
Practice Address - Street 1:13126 1/4 VALLEYHEART DR
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1980
Practice Address - Country:US
Practice Address - Phone:747-356-8388
Practice Address - Fax:323-381-5958
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA142282106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist