Provider Demographics
NPI:1396736195
Name:WOJDOWSKI, PATRICIA (LCSW)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:
Last Name:WOJDOWSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERRY
Other - Middle Name:PATRICIA
Other - Last Name:WOJDOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:4926 LA CUENTA DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92124-2609
Mailing Address - Country:US
Mailing Address - Phone:858-292-0492
Mailing Address - Fax:619-296-2130
Practice Address - Street 1:4926 LA CUENTA DR
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92124-2609
Practice Address - Country:US
Practice Address - Phone:858-292-0492
Practice Address - Fax:619-296-2130
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 85371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW085370OtherMEDICAL
SW8537Medicare ID - Type Unspecified