Healthcare Provider Details

I. General information

NPI: 1629472691
Provider Name (Legal Business Name): ANAIDY CLAUDIO ROSA LSCSW, LCAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 N RIVERVIEW ST STE 730
WICHITA KS
67203-4267
US

IV. Provider business mailing address

3701 E HAVEN DR
DERBY KS
67037-7041
US

V. Phone/Fax

Practice location:
  • Phone: 316-395-2886
  • Fax:
Mailing address:
  • Phone: 316-284-7730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number4800
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberLMSW 9407
License Number StateKS
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number4800
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: