Healthcare Provider Details

I. General information

NPI: 1245424738
Provider Name (Legal Business Name): ANITA MARGARET PRASAD-AGUILERA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MRS. ANITA MARGARET PRASAD

II. Dates (important events)

Enumeration Date: 08/28/2007
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E SHAW AVE STE 109
FRESNO CA
93710-7903
US

IV. Provider business mailing address

4532 N DELNO AVE
FRESNO CA
93705-1019
US

V. Phone/Fax

Practice location:
  • Phone: 559-712-8800
  • Fax: 559-712-8805
Mailing address:
  • Phone: 559-577-0235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW93256
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: