Provider Demographics
NPI:1083636146
Name:RESNECK-SANNES, HELEN R (PHD)
Entity Type:Individual
Prefix:DR
First Name:HELEN
Middle Name:R
Last Name:RESNECK-SANNES
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:HELEN
Other - Middle Name:
Other - Last Name:RESNECK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:216 SUBURBIA AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-1252
Mailing Address - Country:US
Mailing Address - Phone:831-426-2768
Mailing Address - Fax:831-426-1157
Practice Address - Street 1:216 SUBURBIA AVE
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-1252
Practice Address - Country:US
Practice Address - Phone:831-426-2768
Practice Address - Fax:831-426-1157
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 4723103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY4723OtherPSYCHOLOGY LICENSE
CA00PL47230Medicare ID - Type UnspecifiedMEDICARE NMBER