Provider Demographics
NPI:1568980191
Name:GARRETT, ANNE STREETEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:STREETEN
Last Name:GARRETT
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:ANNIE
Other - Middle Name:STREETEN
Other - Last Name:GARRETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:1125 PICO BLVD #103
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405
Mailing Address - Country:US
Mailing Address - Phone:410-746-6518
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 379
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1542
Practice Address - Country:US
Practice Address - Phone:213-373-4784
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-04
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29353103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical