Provider Demographics
NPI:1164559365
Name:CANEPA, ANITA G (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:G
Last Name:CANEPA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5250 CLAREMONT AVE
Mailing Address - Street 2:SUITE 108
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95207-5700
Mailing Address - Country:US
Mailing Address - Phone:209-472-3745
Mailing Address - Fax:209-472-3746
Practice Address - Street 1:5250 CLAREMONT AVE
Practice Address - Street 2:SUITE 108
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95207-5700
Practice Address - Country:US
Practice Address - Phone:209-472-3745
Practice Address - Fax:209-472-3746
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC38856106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist