Provider Demographics
NPI:1285845412
Name:ANDERSON, DANIA FELLER (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANIA
Middle Name:FELLER
Last Name:ANDERSON
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 1:15 RICHMOND HILL RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:CT
Mailing Address - Zip Code:06883-2031
Mailing Address - Country:US
Mailing Address - Phone:917-575-3674
Mailing Address - Fax:
Practice Address - Street 1:55 E 86TH ST
Practice Address - Street 2:SUITE 1-A RETINA GROUP
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10028-1059
Practice Address - Country:US
Practice Address - Phone:917-575-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-28
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052155-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY226311POtherHIP PROVIDER #
NYP3651833OtherOXFORD PROVIDER #
NY226311POtherHIP PROVIDER #
NYP61357Medicare UPIN