Provider Demographics
NPI:1619972775
Name:PARKER, ANITA LEONE (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:LEONE
Last Name:PARKER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:ANITA
Other - Middle Name:LEONE
Other - Last Name:THOMSON PARKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 245
Mailing Address - Street 2:
Mailing Address - City:CUMMAQUID
Mailing Address - State:MA
Mailing Address - Zip Code:02637-0245
Mailing Address - Country:US
Mailing Address - Phone:508-362-3878
Mailing Address - Fax:
Practice Address - Street 1:30 HIGGINS CROWELL RD
Practice Address - Street 2:
Practice Address - City:WEST YARMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02673-3444
Practice Address - Country:US
Practice Address - Phone:508-778-8580
Practice Address - Fax:508-778-8581
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10234331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPPO393OtherBCBS
MAPPO393OtherBCBS