Provider Demographics
NPI:1376613364
Name:ABBA RICHARD, ANITA ELAINE MARTINA (LCMSW)
Entity Type:Individual
Prefix:MRS
First Name:ANITA
Middle Name:ELAINE MARTINA
Last Name:ABBA RICHARD
Suffix:
Gender:F
Credentials:LCMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1505 HANCOCK ST
Mailing Address - Street 2:
Mailing Address - City:PORT TOWNSEND
Mailing Address - State:WA
Mailing Address - Zip Code:98368-8526
Mailing Address - Country:US
Mailing Address - Phone:360-379-8779
Mailing Address - Fax:360-379-2411
Practice Address - Street 1:1505 HANCOCK ST
Practice Address - Street 2:LIGHTHOUSE CO CENTER
Practice Address - City:PORT TOWNSEND
Practice Address - State:WA
Practice Address - Zip Code:98368
Practice Address - Country:US
Practice Address - Phone:360-379-8779
Practice Address - Fax:360-379-2411
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000047541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical