Provider Demographics
NPI:1043384720
Name:PINCUS, ANNE M (PHD)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:M
Last Name:PINCUS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1070 GRAVENSTEIN HWY S.
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SEBASTOPOL
Mailing Address - State:CA
Mailing Address - Zip Code:95472
Mailing Address - Country:US
Mailing Address - Phone:415-431-3331
Mailing Address - Fax:
Practice Address - Street 1:1070 GRAVENSTEIN HWY S.
Practice Address - Street 2:SUITE 130
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472
Practice Address - Country:US
Practice Address - Phone:415-431-3331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-17
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17590103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY175900Medicaid
CA0PL175900Medicare PIN