Provider Demographics
NPI:1558938548
Name:COLLICA, ANTHONY R (PMHNP)
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:R
Last Name:COLLICA
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:146 PIKE ST
Mailing Address - Street 2:
Mailing Address - City:PORT JERVIS
Mailing Address - State:NY
Mailing Address - Zip Code:12771-1808
Mailing Address - Country:US
Mailing Address - Phone:845-858-1456
Mailing Address - Fax:845-378-3283
Practice Address - Street 1:146 PIKE ST
Practice Address - Street 2:
Practice Address - City:PORT JERVIS
Practice Address - State:NY
Practice Address - Zip Code:12771-1808
Practice Address - Country:US
Practice Address - Phone:845-858-1456
Practice Address - Fax:845-378-3283
Is Sole Proprietor?:No
Enumeration Date:2021-06-08
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY403616363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health