Provider Demographics
NPI:1164796793
Name:DUSIG, MAXINE JUDITH (LMFT)
Entity type:Individual
Prefix:MS
First Name:MAXINE
Middle Name:JUDITH
Last Name:DUSIG
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22121 CLARENDON ST APT 147
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6362
Mailing Address - Country:US
Mailing Address - Phone:818-267-7557
Mailing Address - Fax:
Practice Address - Street 1:22121 CLARENDON ST APT 147
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6362
Practice Address - Country:US
Practice Address - Phone:818-267-7557
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-29
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25445106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA25445OtherLICENSE NUMBER