Provider Demographics
NPI:1437874963
Name:ESCOBOZA-HENRY, ANASTACIA LYNN (MSW)
Entity type:Individual
Prefix:
First Name:ANASTACIA
Middle Name:LYNN
Last Name:ESCOBOZA-HENRY
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:FEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:275 BAKER ST STE A
Mailing Address - Street 2:
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92626-4566
Mailing Address - Country:US
Mailing Address - Phone:714-361-6760
Mailing Address - Fax:
Practice Address - Street 1:275 BAKER ST STE A
Practice Address - Street 2:
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92626-4566
Practice Address - Country:US
Practice Address - Phone:714-361-6760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-06
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA114337104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker