Provider Demographics
NPI:1073080974
Name:ANASTOS, EVELYN J (LCSW)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:J
Last Name:ANASTOS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:303 W 66TH ST APT 13BE
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-6680
Mailing Address - Country:US
Mailing Address - Phone:732-754-0434
Mailing Address - Fax:
Practice Address - Street 1:303 W 66TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-6305
Practice Address - Country:US
Practice Address - Phone:732-754-0434
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-29
Last Update Date:2021-11-30
Deactivation Date:2020-05-05
Deactivation Code:
Reactivation Date:2020-05-20
Provider Licenses
StateLicense IDTaxonomies
NY097031104100000X
NY0922781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty