Provider Demographics
NPI:1043518780
Name:WISE, JOANNA DOROTHY
Entity type:Individual
Prefix:MS
First Name:JOANNA
Middle Name:DOROTHY
Last Name:WISE
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:WISE BRADMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:902 CARMEL AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-2106
Mailing Address - Country:US
Mailing Address - Phone:510-527-4064
Mailing Address - Fax:
Practice Address - Street 1:902 CARMEL AVE STE 4
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2106
Practice Address - Country:US
Practice Address - Phone:510-527-4064
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-04
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW180681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical