1609224278 NPI number — MS. ANNE KATHERINE BUCON LCSW

Table of content: MS. ANNE KATHERINE BUCON LCSW (NPI 1609224278)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609224278 NPI number — MS. ANNE KATHERINE BUCON LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUCON
Provider First Name:
ANNE
Provider Middle Name:
KATHERINE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609224278
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3827 LOS SANTOS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAMERON PARK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95682-8647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-677-0262
Provider Business Mailing Address Fax Number:
530-672-0935

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3827 LOS SANTOS DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CAMERON PARK
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95682-8647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-677-0262
Provider Business Practice Location Address Fax Number:
530-672-0935
Provider Enumeration Date:
05/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 11841 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)