Provider Demographics
NPI:1346414208
Name:CAISIN, ANNA (MA, LMFT)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:CAISIN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18757 BURBANK BLVD STE 125
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-3345
Mailing Address - Country:US
Mailing Address - Phone:818-941-2977
Mailing Address - Fax:818-964-0052
Practice Address - Street 1:18757 BURBANK BLVD STE 125
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356
Practice Address - Country:US
Practice Address - Phone:818-941-2977
Practice Address - Fax:818-964-0052
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-22
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225400000X
CA88486106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA88486OtherLICENSE NUMBER
CA7420Medicaid