Provider Demographics
NPI:1568485506
Name:WALLER, ANNA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:
Last Name:WALLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 E 34TH ST
Mailing Address - Street 2:APT 9G
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-5231
Mailing Address - Country:US
Mailing Address - Phone:212-689-1048
Mailing Address - Fax:646-398-9367
Practice Address - Street 1:333 E 34TH ST
Practice Address - Street 2:APT 9G
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4977
Practice Address - Country:US
Practice Address - Phone:212-689-1048
Practice Address - Fax:646-398-9367
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRPO1174611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical