Provider Demographics
NPI:1083684096
Name:GAUDIOSO, ANTHONY (LMHC, NCC, PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:GAUDIOSO
Suffix:
Gender:M
Credentials:LMHC, NCC, PHD
Other - Prefix:DR
Other - First Name:TONY
Other - Middle Name:
Other - Last Name:GAUDIOSO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHC, NCC, PHD
Mailing Address - Street 1:695 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5500
Mailing Address - Country:US
Mailing Address - Phone:212-729-1450
Mailing Address - Fax:
Practice Address - Street 1:695 BUCK RD
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5500
Practice Address - Country:US
Practice Address - Phone:212-729-1450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000464101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health