Provider Demographics
NPI:1053560581
Name:IWANIER, JUDY B (MSW, LCSW)
Entity type:Individual
Prefix:MS
First Name:JUDY
Middle Name:B
Last Name:IWANIER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1920 FALLBROOK LN
Mailing Address - Street 2:
Mailing Address - City:PETALUMA
Mailing Address - State:CA
Mailing Address - Zip Code:94954
Mailing Address - Country:US
Mailing Address - Phone:707-796-3511
Mailing Address - Fax:
Practice Address - Street 1:5 KELLER ST
Practice Address - Street 2:# 2
Practice Address - City:PETALUMA
Practice Address - State:CA
Practice Address - Zip Code:94952-2349
Practice Address - Country:US
Practice Address - Phone:310-423-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA182991041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical