Provider Demographics
NPI:1073567996
Name:ANISKEVICH, JANE MARIE (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:MARIE
Last Name:ANISKEVICH
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 CORNING BLVD
Mailing Address - Street 2:APT. 3A
Mailing Address - City:CORNING
Mailing Address - State:NY
Mailing Address - Zip Code:14830-2057
Mailing Address - Country:US
Mailing Address - Phone:607-962-2299
Mailing Address - Fax:
Practice Address - Street 1:BUILDING 32
Practice Address - Street 2:BATH VA MEDICAL CENTER
Practice Address - City:BATH
Practice Address - State:NY
Practice Address - Zip Code:14810
Practice Address - Country:US
Practice Address - Phone:607-664-4512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR048620-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical