Provider Demographics
NPI:1578793063
Name:PAPADOPOULOS, ANASTASIA M
Entity Type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:M
Last Name:PAPADOPOULOS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19 GREENRIDGE AVE
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10605-1201
Mailing Address - Country:US
Mailing Address - Phone:914-949-7680
Mailing Address - Fax:914-997-7942
Practice Address - Street 1:19 GREENRIDGE AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10605-1201
Practice Address - Country:US
Practice Address - Phone:914-949-7680
Practice Address - Fax:914-997-7942
Is Sole Proprietor?:No
Enumeration Date:2009-07-20
Last Update Date:2009-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0764421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00355940OtherAGENCY MEDICAID #
NY1285628552OtherAGENCY NPI
NYWVE061OtherAGENCY MEDICARE #