Provider Demographics
NPI:1144422437
Name:HATTENDORF, ANITA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:MARIE
Last Name:HATTENDORF
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 1:8861 WILLIAMSON DR STE 40
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-1878
Mailing Address - Country:US
Mailing Address - Phone:916-685-5258
Mailing Address - Fax:916-670-7880
Practice Address - Street 1:8861 WILLIAMSON DR STE 40
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-1878
Practice Address - Country:US
Practice Address - Phone:916-685-5258
Practice Address - Fax:916-670-7880
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS194981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical