Doctor Name: | ANNA DEC |
NPI Number: | 1023387016 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | CASAC |
License Number: | |
Business Practice Address: | 6801 Fresh Pond Rd Apt.2f Ridgewood, NY - 113855233 |
Business Phone Number: | 9176002158 |
Business Fax Number: | |
Mailing Address: | 6801 Fresh Pond Rd, Apt.2f RIDGEWOOD |
State: | NY |
Postal Code: | 113855233 |
Phone Number: | 0176002158 |
Fax Number: | |
NPI Enumeration Date: | 12/20/2011 |
NPI Last Update Date: | 12/20/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |