Provider Demographics
NPI:1609148949
Name:GIFFORD, ANNA M (LMHC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:GIFFORD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2546 COUNTY HOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PENN YAN
Mailing Address - State:NY
Mailing Address - Zip Code:14527-9315
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:465 N MAIN ST
Practice Address - Street 2:JOHN D. KELLY BEHAVIORIAL HEALTH
Practice Address - City:PENN YAN
Practice Address - State:NY
Practice Address - Zip Code:14527-1069
Practice Address - Country:US
Practice Address - Phone:315-531-2420
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-02
Last Update Date:2012-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003852101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health