Healthcare Provider Details

I. General information

NPI: 1457796047
Provider Name (Legal Business Name): ANITA KRAMER LISW-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2013
Last Update Date: 09/07/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

366 E JEFFREY PL
COLUMBUS OH
43214-1714
US

IV. Provider business mailing address

366 E JEFFREY PL
COLUMBUS OH
43214-1714
US

V. Phone/Fax

Practice location:
  • Phone: 760-805-5262
  • Fax:
Mailing address:
  • Phone: 760-805-5262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63954
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1901696
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: