| Doctor Name: | MR. ANTHONY HERBERT PRIMUS |
| NPI Number: | 1215239660 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LMSW |
| License Number: | 070224-1 |
| Business Practice Address: | 10 Kayleen Dr New Windsor, NY - 125537030 |
| Business Phone Number: | 8455656888 |
| Business Fax Number: | |
| Mailing Address: | 57 Bayberry Dr, MONROE |
| State: | NY |
| Postal Code: | 109505607 |
| Phone Number: | 8457832167 |
| Fax Number: | |
| NPI Enumeration Date: | 11/17/2010 |
| NPI Last Update Date: | 11/17/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 070224-1 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |