Provider Demographics
NPI:1629560768
Name:ENTENMAN, LUCY ANN (LICSW)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:ANN
Last Name:ENTENMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LUCY
Other - Middle Name:ANN
Other - Last Name:LANKFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5671 NW HOOD LOOP
Mailing Address - Street 2:
Mailing Address - City:CAMAS
Mailing Address - State:WA
Mailing Address - Zip Code:98607
Mailing Address - Country:US
Mailing Address - Phone:360-521-3854
Mailing Address - Fax:
Practice Address - Street 1:332 NICHOLS RD
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-6113
Practice Address - Country:US
Practice Address - Phone:360-521-3854
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-05
Last Update Date:2021-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA607784781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical