Provider Demographics
NPI:1174634257
Name:HALBERSTADT-KOMAR, ANNA (MA LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:HALBERSTADT-KOMAR
Suffix:
Gender:F
Credentials:MA LCSW
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:
Other - Last Name:CHERUPISTAYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:718 BROADWAY
Mailing Address - Street 2:#5D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-777-6653
Mailing Address - Fax:212-777-6653
Practice Address - Street 1:920 BROADWAY
Practice Address - Street 2:8 FLOOR, ST. 12
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:646-248-0788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPRO 34753-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNS4095OtherOXFORD
NYNS4095OtherOXFORD
S04187Medicare UPIN