Provider Demographics
NPI:1245592310
Name:ANTHONY, DJINEFA
Entity Type:Individual
Prefix:
First Name:DJINEFA
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 HENLEY RD
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-2448
Mailing Address - Country:US
Mailing Address - Phone:718-607-5389
Mailing Address - Fax:718-264-3250
Practice Address - Street 1:18623 HENLEY RD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-2448
Practice Address - Country:US
Practice Address - Phone:718-607-5389
Practice Address - Fax:718-264-3250
Is Sole Proprietor?:No
Enumeration Date:2012-06-13
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1158992103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst