Provider Demographics
NPI:1023154556
Name:GWIRE, ANNETTE ROSINA (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNETTE
Middle Name:ROSINA
Last Name:GWIRE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANNETTE
Other - Middle Name:ROSINA
Other - Last Name:PONT GWIRE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:555 JUNIPERO SERRA BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94127
Mailing Address - Country:US
Mailing Address - Phone:415-586-4855
Mailing Address - Fax:
Practice Address - Street 1:555 JUNIPERO SERRA BLVD
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94127
Practice Address - Country:US
Practice Address - Phone:415-333-4766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACAPSY11528103TC0700X
CACA MFCC MZ 23522106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist