Individual
ANN PRINDIVILLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
104 WALNUT AVE STE 208, SANTA CRUZ, CA 95060-3929
(831) 423-9444
Mailing address
104 WALNUT AVE STE 208, SANTA CRUZ, CA 95060-3929
(831) 423-9444
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LCSW21544
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LCS 21544
PROFESSIONAL LICENSE#
CA
01
—
ZZZ91891Z
MEDICARE GROUP ID#
CA
01
—
ZZZ91892Z
MEDICARE GROUP ID#
CA
01
—
ZZZ92069Z
MEDICARE GROUP ID#
CA
01
—
ZZZ92073Z
MEDCIARE GROUP ID#
CA
Enumeration date
09/20/2006
Last updated
09/20/2018
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