Provider Demographics
NPI:1730918202
Name:VISHNYAKOVA, ANNA G
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:G
Last Name:VISHNYAKOVA
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 1:26 WOODHAVEN CT
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94131-1128
Mailing Address - Country:US
Mailing Address - Phone:415-602-9354
Mailing Address - Fax:
Practice Address - Street 1:300 TAMAL PLZ STE 280
Practice Address - Street 2:
Practice Address - City:CORTE MADERA
Practice Address - State:CA
Practice Address - Zip Code:94925-1136
Practice Address - Country:US
Practice Address - Phone:415-888-8087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-31
Last Update Date:2024-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139329106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist