Provider Demographics
NPI:1619155629
Name:KAMBLY, ANNE MARIE (LCSW)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:MARIE
Last Name:KAMBLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:DR
Other - First Name:ANNE
Other - Middle Name:MARIE
Other - Last Name:KAMBLY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 2046
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94912-2046
Mailing Address - Country:US
Mailing Address - Phone:415-883-7789
Mailing Address - Fax:
Practice Address - Street 1:551 BOLLING CIR
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-6483
Practice Address - Country:US
Practice Address - Phone:415-883-7789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS90371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical