Healthcare Provider Details

I. General information

NPI: 1194376830
Provider Name (Legal Business Name): DAVID ALAN RESNIKOFF
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2019
Last Update Date: 01/03/2020
Certification Date: 01/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2901 PARK AVE # B8
SOQUEL CA
95073-2831
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 Number
License Number State

VIII. Authorized Official

Name: DAVID ALAN RESNIKOFF
Title or Position: OWNER
Credential: MSW, LCSW
Phone: 831-471-5044