Provider Demographics
NPI:1760565162
Name:HRISHIKESAN, ANITA GOURI (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:GOURI
Last Name:HRISHIKESAN
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 1:655 ULTIMO AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90814-2048
Mailing Address - Country:US
Mailing Address - Phone:562-597-2469
Mailing Address - Fax:
Practice Address - Street 1:655 ULTIMO AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90814-2048
Practice Address - Country:US
Practice Address - Phone:562-597-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA143711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical