Provider Demographics
NPI:1154424273
Name:NANNA, NANCY C (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:C
Last Name:NANNA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:514 S SCHOOL ST
Mailing Address - Street 2:104
Mailing Address - City:UKIAH
Mailing Address - State:CA
Mailing Address - Zip Code:95482-5438
Mailing Address - Country:US
Mailing Address - Phone:707-468-9452
Mailing Address - Fax:707-468-9452
Practice Address - Street 1:514 S SCHOOL ST
Practice Address - Street 2:104
Practice Address - City:UKIAH
Practice Address - State:CA
Practice Address - Zip Code:95482-5438
Practice Address - Country:US
Practice Address - Phone:707-468-9452
Practice Address - Fax:707-468-9452
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 16792101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ01112ZMedicare ID - Type Unspecified