Provider Demographics
NPI:1891893392
Name:PRINDIVILLE, ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:PRINDIVILLE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:
Other - Last Name:PRINDIVILLE-STOLL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCS W
Mailing Address - Street 1:104 WALNUT AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-3929
Mailing Address - Country:US
Mailing Address - Phone:831-423-9444
Mailing Address - Fax:
Practice Address - Street 1:104 WALNUT AVE STE 208
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-3929
Practice Address - Country:US
Practice Address - Phone:831-423-9444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW215441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 21544OtherPROFESSIONAL LICENSE#
CAZZZ91892ZOtherMEDICARE GROUP ID#
CAZZZ92069ZOtherMEDICARE GROUP ID#
CAZZZ92073ZOtherMEDCIARE GROUP ID#
CAZZZ91891ZOtherMEDICARE GROUP ID#
CAZZZ02688ZMedicare PIN