License Detail

NameANZALONE TINA BETH
AddressCHEEKTOWAGANY
ProfessionLICENSED CLINICAL SOCIAL WORK
License No041638
Date of Licensure09/01/04  (OriginallylicensedasaCertifiedSocialWorkeron09/05/90)
Additional QualificationR -Psychotherapy Privilege
StatusREGISTERED
Registered through last day of

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