Provider Demographics
NPI:1629149463
Name:PANKRATZ, GRETA ANN (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:GRETA
Middle Name:ANN
Last Name:PANKRATZ
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 434
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93456-0434
Mailing Address - Country:US
Mailing Address - Phone:805-268-5317
Mailing Address - Fax:
Practice Address - Street 1:235 W CLARK AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93455-4622
Practice Address - Country:US
Practice Address - Phone:805-268-5317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA256871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical