Provider Demographics
NPI:1871117366
Name:MENCHACA, ANNETTE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ANNETTE
Middle Name:
Last Name:MENCHACA
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 1:17542 17TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-1960
Mailing Address - Country:US
Mailing Address - Phone:714-788-1376
Mailing Address - Fax:
Practice Address - Street 1:17542 17TH ST STE 300
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-1960
Practice Address - Country:US
Practice Address - Phone:714-788-1376
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-01
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW662591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical