Provider Demographics
NPI:1104464213
Name:LASSEN FOLEY, ANNE SOFIE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:SOFIE
Last Name:LASSEN FOLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31111 VIA SOLANA
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN CAPISTRANO
Mailing Address - State:CA
Mailing Address - Zip Code:92675-2919
Mailing Address - Country:US
Mailing Address - Phone:562-552-7324
Mailing Address - Fax:
Practice Address - Street 1:31111 VIA SOLANA
Practice Address - Street 2:
Practice Address - City:SAN JUAN CAPISTRANO
Practice Address - State:CA
Practice Address - Zip Code:92675-2919
Practice Address - Country:US
Practice Address - Phone:562-552-7324
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-19
Last Update Date:2022-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA113641106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor