Provider Demographics
NPI:1174857775
Name:CITRIN, ANNEKA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNEKA
Middle Name:
Last Name:CITRIN
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 1:205 39TH ST
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94805-2212
Mailing Address - Country:US
Mailing Address - Phone:510-492-5930
Mailing Address - Fax:510-492-0567
Practice Address - Street 1:205 39TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94805-2212
Practice Address - Country:US
Practice Address - Phone:510-492-5930
Practice Address - Fax:510-492-0567
Is Sole Proprietor?:No
Enumeration Date:2009-09-29
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW683531041C0700X
104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker