Provider Demographics
NPI:1033780150
Name:ANDERSON, MICHAEL VINCENT (LMHC)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:VINCENT
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 BLUE HILL COMMONS DR UNIT C
Mailing Address - Street 2:
Mailing Address - City:ORANGEBURG
Mailing Address - State:NY
Mailing Address - Zip Code:10962-2182
Mailing Address - Country:US
Mailing Address - Phone:845-825-4913
Mailing Address - Fax:
Practice Address - Street 1:11 BLUE HILL COMMONS DR UNIT C
Practice Address - Street 2:
Practice Address - City:ORANGEBURG
Practice Address - State:NY
Practice Address - Zip Code:10962-2182
Practice Address - Country:US
Practice Address - Phone:845-825-4913
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-09
Last Update Date:2022-09-29
Deactivation Date:2022-08-15
Deactivation Code:
Reactivation Date:2022-09-29
Provider Licenses
StateLicense IDTaxonomies
NY01149101YM0800X
NY011449101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty