Provider Demographics
NPI:1568692739
Name:ANTHONY, ANNAMARIA (PHD)
Entity Type:Individual
Prefix:
First Name:ANNAMARIA
Middle Name:
Last Name:ANTHONY
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:PO BOX 1500, PMB 226
Mailing Address - Street 2:
Mailing Address - City:BROOKINGS
Mailing Address - State:OR
Mailing Address - Zip Code:97415-7152
Mailing Address - Country:US
Mailing Address - Phone:541-469-4347
Mailing Address - Fax:
Practice Address - Street 1:603 HEMLOCK ST
Practice Address - Street 2:STE 2E
Practice Address - City:BROOKINGS
Practice Address - State:OR
Practice Address - Zip Code:97415-9429
Practice Address - Country:US
Practice Address - Phone:541-469-4347
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-21
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3044103T00000X
CA19998103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist