Provider Demographics
NPI:1942659024
Name:VINCELETTE, ANNE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:
Last Name:VINCELETTE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1405
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94948-1405
Mailing Address - Country:US
Mailing Address - Phone:707-385-1681
Mailing Address - Fax:
Practice Address - Street 1:405 ENFRENTE RD STE 220
Practice Address - Street 2:
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94949-7201
Practice Address - Country:US
Practice Address - Phone:707-385-1681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-08
Last Update Date:2022-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28354103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA100171223Medicaid
CACA281658Medicaid