Basic Information
Provider Information
NPI: 1518928357
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: WALKER
FirstName: ANNE
MiddleName: E.
NamePrefix: MS.
NameSuffix:  
Credential: MA LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 35 ARROYO DR
Address2:  
City: MORAGA
State: CA
PostalCode: 945561228
CountryCode: US
TelephoneNumber: 5592256100
FaxNumber:  
Practice Location
Address1: 2615 E CLINTON AVE
Address2:  
City: FRESNO
State: CA
PostalCode: 937032223
CountryCode: US
TelephoneNumber: 5592256100
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/31/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
104100000XLCSW14563CAY Behavioral Health & Social Service ProvidersSocial Worker 

No ID Information.


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