Provider Demographics
NPI:1326768078
Name:ANFANG, BOBBY ROSS (SOCIAL WORKER)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:ROSS
Last Name:ANFANG
Suffix:
Gender:M
Credentials:SOCIAL WORKER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 WINGATE STREET APARTMENT 10
Mailing Address - Street 2:
Mailing Address - City:BEERSHEVA
Mailing Address - State:ISRAEL
Mailing Address - Zip Code:8442894
Mailing Address - Country:IL
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 WINGATE STREET APARTMENT 10
Practice Address - Street 2:
Practice Address - City:BEERSHEVA
Practice Address - State:ISRAEL
Practice Address - Zip Code:8442894
Practice Address - Country:IL
Practice Address - Phone:718-667-7674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-01
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY087815-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker