Provider Demographics
NPI:1902381395
Name:ANANDARAYNE LICENSED CLINICAL SOCIAL WORKER CORP
Entity Type:Organization
Organization Name:ANANDARAYNE LICENSED CLINICAL SOCIAL WORKER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARI
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-246-9156
Mailing Address - Street 1:2535 16TH ST STE 205
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-3417
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2535 16TH ST STE 205
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-3417
Practice Address - Country:US
Practice Address - Phone:661-889-1562
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-01
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health