Provider Demographics
NPI:1205982147
Name:FAMILY SERVICE AGENCY OF SONOMA COUNTY
Entity type:Organization
Organization Name:FAMILY SERVICE AGENCY OF SONOMA COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ANYA
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:707-545-4551
Mailing Address - Street 1:751 LOMBARDI CT STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95407-6793
Mailing Address - Country:US
Mailing Address - Phone:707-545-4551
Mailing Address - Fax:
Practice Address - Street 1:751 LOMBARDI CT STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95407-6793
Practice Address - Country:US
Practice Address - Phone:707-545-4551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACMM70480FOtherOUTPATIENT MENTAL HEALTH