Provider Demographics
NPI:1003691122
Name:VINCENT, CLARISSA RENEE' (ASW #107903)
Entity Type:Individual
Prefix:
First Name:CLARISSA
Middle Name:RENEE'
Last Name:VINCENT
Suffix:
Gender:F
Credentials:ASW #107903
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-5424
Mailing Address - Country:US
Mailing Address - Phone:760-509-3424
Mailing Address - Fax:
Practice Address - Street 1:334 VIA VERA CRUZ
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-2635
Practice Address - Country:US
Practice Address - Phone:760-509-3424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical