Provider Demographics
NPI:1588671242
Name:KOSINSKI, ANN LUCILLE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:LUCILLE
Last Name:KOSINSKI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:LUCILLE
Other - Last Name:WALDBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2550 HONOLULU AVE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:MONTROSE
Mailing Address - State:CA
Mailing Address - Zip Code:91020-1858
Mailing Address - Country:US
Mailing Address - Phone:805-658-8180
Mailing Address - Fax:805-650-6855
Practice Address - Street 1:500 ESPLANADE DRIVE
Practice Address - Street 2:SUITE 1140
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0558
Practice Address - Country:US
Practice Address - Phone:805-658-8180
Practice Address - Fax:805-650-6855
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS77111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
19410813OtherHORIZON HEALTH
903703OtherPACIFICARE
0007980105OtherAETNA
903703OtherPACIFICARE