Provider Demographics
NPI:1376788604
Name:ANTHONY GAUDIOSO, PH.D, LICENSED MENTAL HEALTH COUNSELOR, P.C.
Entity Type:Organization
Organization Name:ANTHONY GAUDIOSO, PH.D, LICENSED MENTAL HEALTH COUNSELOR, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:GAUDIOSO
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC, NCC, PHD
Authorized Official - Phone:212-729-1450
Mailing Address - Street 1:695 BUCK RD
Mailing Address - Street 2:
Mailing Address - City:STONE RIDGE
Mailing Address - State:NY
Mailing Address - Zip Code:12484-5500
Mailing Address - Country:US
Mailing Address - Phone:212-729-1450
Mailing Address - Fax:917-470-9330
Practice Address - Street 1:695 BUCK RD
Practice Address - Street 2:
Practice Address - City:STONE RIDGE
Practice Address - State:NY
Practice Address - Zip Code:12484-5500
Practice Address - Country:US
Practice Address - Phone:917-470-9224
Practice Address - Fax:917-470-9330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000464-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty