Provider Demographics
NPI:1568797728
Name:ANAYA, MARIA ALICIA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ALICIA
Last Name:ANAYA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ALICIA
Other - Last Name:RAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1208 9TH ST
Mailing Address - Street 2:MODESTO
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95354-0713
Mailing Address - Country:US
Mailing Address - Phone:209-604-9009
Mailing Address - Fax:209-558-4450
Practice Address - Street 1:1208 9TH ST
Practice Address - Street 2:MODESTO
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95354-0713
Practice Address - Country:US
Practice Address - Phone:209-604-9009
Practice Address - Fax:209-558-4450
Is Sole Proprietor?:No
Enumeration Date:2009-10-06
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CALCSW763131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health