Provider Demographics
NPI:1235163411
Name:RADOV, ANEITA SHARPLES (MA, LMFT, CEAP)
Entity Type:Individual
Prefix:MS
First Name:ANEITA
Middle Name:SHARPLES
Last Name:RADOV
Suffix:
Gender:F
Credentials:MA, LMFT, CEAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3121 PARK AVE
Mailing Address - Street 2:SUITE I
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2920
Mailing Address - Country:US
Mailing Address - Phone:831-476-1552
Mailing Address - Fax:831-476-4750
Practice Address - Street 1:3121 PARK AVE
Practice Address - Street 2:SUITE I
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2920
Practice Address - Country:US
Practice Address - Phone:831-476-1552
Practice Address - Fax:831-476-4750
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 19712106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0001007006OtherMANAGED HEALTH NET VENDOR
CA54220ZZZ95485ZOtherBLUE SHIELD OF CA