Provider Demographics
NPI:1811762941
Name:MICHAEL ANNORENO LICENSED CLINICAL SOCIAL WORKER APC
Entity type:Organization
Organization Name:MICHAEL ANNORENO LICENSED CLINICAL SOCIAL WORKER APC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNORENO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-810-7886
Mailing Address - Street 1:39338 BEACON LN
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1089
Mailing Address - Country:US
Mailing Address - Phone:661-810-7886
Mailing Address - Fax:
Practice Address - Street 1:848 W LANCASTER BLVD STE 102
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-2347
Practice Address - Country:US
Practice Address - Phone:661-441-6568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-20
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty