Provider Demographics
NPI:1679966360
Name:BEARHEART, ANNE
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:BEARHEART
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 ANDRIEUX ST STE 212
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-6920
Mailing Address - Country:US
Mailing Address - Phone:707-935-2243
Mailing Address - Fax:
Practice Address - Street 1:181 ANDRIEUX ST STE 212
Practice Address - Street 2:
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476-6920
Practice Address - Country:US
Practice Address - Phone:707-935-2243
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-05
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12734103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist