Provider Demographics
NPI:1639619356
Name:ANDERSON, VANESSA RENEE
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:RENEE
Last Name:ANDERSON
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 1:820 BOYNTON AVENUE
Mailing Address - Street 2:APARTMENT 8D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10473
Mailing Address - Country:US
Mailing Address - Phone:347-718-1309
Mailing Address - Fax:
Practice Address - Street 1:820 BOYNTON AVE
Practice Address - Street 2:APARTMENT 8D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10473-4648
Practice Address - Country:US
Practice Address - Phone:347-237-0590
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-28
Last Update Date:2024-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician