Healthcare Provider Details

I. General information

NPI: 1780830513
Provider Name (Legal Business Name): DAVID ALAN RESNIKOFF LCS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 RIVER ST STE 11
SANTA CRUZ CA
95060-2748
US

IV. Provider business mailing address

PO BOX 514
SANTA CRUZ CA
95061-0514
US

V. Phone/Fax

Practice location:
  • Phone: 831-471-5044
  • Fax:
Mailing address:
  • Phone: 831-471-5044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS 24687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: