Provider Demographics
NPI:1083131791
Name:VAN VOORENE, ANNUNZIATA JOHANNA PAULINA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANNUNZIATA
Middle Name:JOHANNA PAULINA
Last Name:VAN VOORENE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 1127
Mailing Address - Street 2:
Mailing Address - City:LOWER LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:95457
Mailing Address - Country:US
Mailing Address - Phone:707-480-7319
Mailing Address - Fax:
Practice Address - Street 1:11686 SPRUCE GROVE RD
Practice Address - Street 2:
Practice Address - City:LOWER LAKE
Practice Address - State:CA
Practice Address - Zip Code:95457-9545
Practice Address - Country:US
Practice Address - Phone:707-994-4053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW78653101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional