Healthcare Provider Details

I. General information

NPI: 1043456171
Provider Name (Legal Business Name): ANTHONY YRIGOLLEN L.C.S.W
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6051 N FRESNO ST STE 201
FRESNO CA
93710-5280
US

IV. Provider business mailing address

7212 W WHITMAN AVE
FRESNO CA
93723-4114
US

V. Phone/Fax

Practice location:
  • Phone: 559-917-3516
  • Fax:
Mailing address:
  • Phone: 559-917-3516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number76307
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: