Provider Demographics
NPI:1689928418
Name:MUNOZ, ANA ROSA (LCSW)
Entity type:Individual
Prefix:
First Name:ANA ROSA
Middle Name:
Last Name:MUNOZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANA ROSA
Other - Middle Name:
Other - Last Name:MERCADO MUNOZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:3761 BASSETTI CT
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-7401
Mailing Address - Country:US
Mailing Address - Phone:209-604-3211
Mailing Address - Fax:
Practice Address - Street 1:1420 W H ST
Practice Address - Street 2:
Practice Address - City:OAKDALE
Practice Address - State:CA
Practice Address - Zip Code:95361
Practice Address - Country:US
Practice Address - Phone:209-848-4103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-31
Last Update Date:2024-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA810061041C0700X
101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional