Healthcare Provider Details

I. General information

NPI: 1538360169
Provider Name (Legal Business Name): ANNA VAISMAN ENNIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/30/2007
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 E COLORADO BLVD SUITE 180 & 2ND FLOOR
PASADENA CA
91101-6143
US

IV. Provider business mailing address

10190 PEBBLE BEACH DR
SANTEE CA
92071-2024
US

V. Phone/Fax

Practice location:
  • Phone: 619-377-1289
  • Fax: 619-415-8133
Mailing address:
  • Phone: 619-517-2662
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5071699
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number71559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: