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General NPI Number Information
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NPI Number | 1194376830
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Entity Type | Organization
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Legal Business Name | DAVID ALAN RESNIKOFF
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Dates
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Enumeration Date | 09/24/2019
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Last Update Date | 01/03/2020
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Provider Practice Location Address
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Address Line | 2901 PARK AVE # B8
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City | SOQUEL
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State | CA
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Zip | 95073-2831
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Country | US
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Telephone | 831-471-5044
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 514
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City | SANTA CRUZ
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State | CA
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Zip | 95061-0514
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Country | US
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Telephone | 831-471-5044
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAVID ALAN RESNIKOFF
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Credential | MSW, LCSW
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Telephone | 831-471-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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