Provider Demographics
NPI:1770903502
Name:DITIBERIO, ANNE (LCSW, PPSC)
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:DITIBERIO
Suffix:
Gender:F
Credentials:LCSW, PPSC
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 60953
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-0953
Mailing Address - Country:US
Mailing Address - Phone:650-207-6694
Mailing Address - Fax:
Practice Address - Street 1:715 COLORADO AVE
Practice Address - Street 2:SUITE A
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94303-3907
Practice Address - Country:US
Practice Address - Phone:650-207-6694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-19
Last Update Date:2014-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA605791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical