Provider Demographics
NPI:1164651287
Name:ANAGNOSTIS, BETH LARA (LCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:LARA
Last Name:ANAGNOSTIS
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 1:691 CEDAR LN
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-1702
Mailing Address - Country:US
Mailing Address - Phone:201-692-0508
Mailing Address - Fax:201-692-1691
Practice Address - Street 1:691 CEDAR LN
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-1702
Practice Address - Country:US
Practice Address - Phone:201-692-0508
Practice Address - Fax:201-692-1691
Is Sole Proprietor?:No
Enumeration Date:2009-07-10
Last Update Date:2009-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC046266001041C0700X
NY61837671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical