Provider Demographics
NPI:1629599501
Name:LOVELACE, ANNA RAE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:RAE
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 S 19TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-4615
Mailing Address - Country:US
Mailing Address - Phone:215-789-9167
Mailing Address - Fax:
Practice Address - Street 1:1509 S 19TH ST FL 2
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-4615
Practice Address - Country:US
Practice Address - Phone:215-789-9167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-30
Last Update Date:2021-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health