Provider Demographics
NPI:1336651124
Name:ANDRIC, KSENIJA (LCSW)
Entity Type:Individual
Prefix:
First Name:KSENIJA
Middle Name:
Last Name:ANDRIC
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:KSENIJA
Other - Middle Name:ANDRIC
Other - Last Name:NORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3101 HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-3925
Mailing Address - Country:US
Mailing Address - Phone:805-407-7026
Mailing Address - Fax:
Practice Address - Street 1:790 E SANTA CLARA ST STE 102
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93001-2967
Practice Address - Country:US
Practice Address - Phone:805-407-7026
Practice Address - Fax:805-407-7026
Is Sole Proprietor?:Yes
Enumeration Date:2017-11-02
Last Update Date:2017-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA801481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical