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NPI Code Detail

MEDICARE: ANNA VAISMAN ENNIS LCSW

MEDICARE: ANNA VAISMAN ENNIS LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker5071699ID
21041C0700XClinical Social Worker71559CA

General Provider Information

NPI Number : 1538360169
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA VAISMAN ENNIS LCSW
Provider Business Mailing Address
First Line : 10190 PEBBLE BEACH DR
Second Line :
City : SANTEE
State : CA
Zip : 92071-2024
Country : US
Telephone Number : 619-517-2662
Fax Number :
Provider Business Practice Location Address
First Line : 680 E COLORADO BLVD
Second Line : SUITE 180 & 2ND FLOOR
City : PASADENA
State : CA
Zip : 91101-6143
Country : US
Telephone Number : 619-377-1289
Fax Number : 619-415-8133
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/30/2007
Last Update Date : 06/26/2026

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Directions to “ ANNA VAISMAN ENNIS LCSW” Practice Location

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