Provider Demographics
NPI:1437934676
Name:VANDERVEEN, ANNEKA WYNNE (LMSW)
Entity Type:Individual
Prefix:
First Name:ANNEKA
Middle Name:WYNNE
Last Name:VANDERVEEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 WOOD DALE DR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12019-9335
Mailing Address - Country:US
Mailing Address - Phone:401-663-9057
Mailing Address - Fax:
Practice Address - Street 1:160 WOOD DALE DR
Practice Address - Street 2:
Practice Address - City:BALLSTON LAKE
Practice Address - State:NY
Practice Address - Zip Code:12019-9335
Practice Address - Country:US
Practice Address - Phone:401-663-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY119141104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker