Individual provider Active NPI

Anna Vaisman Ennis, LCSW

  • Clinical Social Worker
  • Pasadena, CA
National Provider Identifier
1538360169
Registry record updated Aug 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
71559 Issued in CA
Practice address
680 E Colorado Blvd
Suite 180 & 2ND Floor
Pasadena, CA 91101-6143
Phone
(619) 377-1289
Fax
(619) 415-8133
NPI assigned
May 30, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 17, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 5071699 ID
Clinical Social Worker 1041C0700X 71559 CA Primary

Addresses

Primary practice location

680 E Colorado Blvd
Suite 180 & 2ND Floor
Pasadena, CA 91101-6143

Mailing address

7670 Opportunity Rd Ste 255
San Diego, CA 92111-2272
Phone (619) 377-1289

Other practice location 1

7670 Opportunity Rd Ste 255
San Diego, CA 92111-2272
Phone (619) 377-1289

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
71559CAMDPharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1786924800000",
    "number": "1538360169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7670 OPPORTUNITY RD STE 255",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921112272",
            "telephone_number": "619-377-1289",
            "fax_number": "619-415-8133"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "680 E COLORADO BLVD",
            "address_2": "SUITE 180 & 2ND FLOOR",
            "city": "PASADENA",
            "state": "CA",
            "postal_code": "911016143",
            "telephone_number": "619-377-1289",
            "fax_number": "619-415-8133"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "7670 Opportunity Rd Ste 255",
            "address_purpose": "LOCATION",
            "city": "San Diego",
            "state": "CA",
            "postal_code": "921112272",
            "country_code": "US",
            "telephone_number": "619-377-1289",
            "fax_number": "619-415-8133",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ENNIS",
        "first_name": "ANNA",
        "middle_name": "VAISMAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-05-30",
        "last_updated": "2026-08-17",
        "certification_date": "2026-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "ID",
            "license": "5071699",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "71559",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Pasadena, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.