Individual
MS. ANEITA SHARPLES RADOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA, LMFT, CEAP
Contact information
Practice address
3121 PARK AVE, SUITE I, SOQUEL, CA 95073-2920
(831) 476-1552
(831) 476-4750
Mailing address
3121 PARK AVE, SUITE I, SOQUEL, CA 95073-2920
(831) 476-1552
(831) 476-4750
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
MFC 19712
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001007006
MANAGED HEALTH NET VENDOR
CA
01
—
54220ZZZ95485Z
BLUE SHIELD OF CA
CA
Enumeration date
07/11/2006
Last updated
07/08/2007
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