MEDICARE: DAVID ALAN RESNIKOFF LCS

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
1	1041C0700X	Clinical Social Worker	LCS 24687	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	LCS 24687	OTHER	CA	PROFESSIONAL LICENSE

General Provider Information

NPI Number	:	1780830513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID ALAN RESNIKOFF LCS

Provider Business Mailing Address
First Line	:	PO BOX 514
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95061-0514
Country	:	US
Telephone Number	:	831-471-5044
Fax Number	:

Provider Business Practice Location Address
First Line	:	710 RIVER ST STE 11
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-2748
Country	:	US
Telephone Number	:	831-471-5044
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	12/08/2025

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Directions to “ DAVID ALAN RESNIKOFF LCS” Practice Location

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