Provider Demographics
NPI:1578815429
Name:NISENZON, ANNE NOELLE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:NOELLE
Last Name:NISENZON
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 1:11 SILVER HILL LN
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-4731
Mailing Address - Country:US
Mailing Address - Phone:609-332-7530
Mailing Address - Fax:
Practice Address - Street 1:1528 WALNUT ST STE 1402
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102
Practice Address - Country:US
Practice Address - Phone:267-540-8583
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-02
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25172103TC0700X
PAPS017791103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical