Dana Mokrzycka Wideman, PH.D

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY11581 Issued in CA

Practice address

241 S San Antonio Rd
Los Altos, CA 94022-3751

Phone

(650) 328-5645

NPI assigned

Feb 2, 2024

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1706832000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1706832000000",
    "number": "1497518328",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "241 S SAN ANTONIO RD",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940223751",
            "telephone_number": "650-328-5645"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "241 S SAN ANTONIO RD",
            "city": "LOS ALTOS",
            "state": "CA",
            "postal_code": "940223751",
            "telephone_number": "650-328-5645"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WIDEMAN",
        "first_name": "DANA",
        "middle_name": "MOKRZYCKA",
        "name_prefix": "Dr.",
        "credential": "PH.D",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2024-02-02",
        "last_updated": "2024-02-02",
        "certification_date": "2024-02-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY11581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Lance Stanley Westcott, P.T.
• Lynn Westphal, MD
• Nancy L Wetmore, CMT
• White Cedar Acupuncture a Professional Corporation
• Kevin M. White, M.D.
• Barbara C Widney, LMFTT
• William M Dolan MD a Professional Corporation
• Carol Denise Williams, PH.D.
• Elizabeth Williams
• Judith Kimball Williams, LMFT

• Clinical Psychologist in Los Altos, CA
• Providers in Los Altos, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.