Provider Demographics
NPI:1841748191
Name:ANAYA-BACA, SUSANA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SUSANA
Middle Name:
Last Name:ANAYA-BACA
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 1:29970 TECHNOLOGY DR STE 116
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-2647
Mailing Address - Country:US
Mailing Address - Phone:951-778-0230
Mailing Address - Fax:
Practice Address - Street 1:29970 TECHNOLOGY DR STE 116
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563
Practice Address - Country:US
Practice Address - Phone:951-778-0230
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-15
Last Update Date:2018-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW690561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical