Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LCS 22996 | CA |
NPI | 1003022534 |
---|---|
Provider Name | Ms. Diane Hutt Anderson |
First Address | Glendora, CA 91740-4003 |
Second Address | Glendora, CA 91740 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2007 |
Last Update Date | 04/08/2014 |