Provider Demographics
NPI:1679023212
Name:ANTHONY, MOSHE (LMSW)
Entity Type:Individual
Prefix:
First Name:MOSHE
Middle Name:
Last Name:ANTHONY
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 BROADWAY
Mailing Address - Street 2:APT. 1
Mailing Address - City:HEWLETT
Mailing Address - State:NY
Mailing Address - Zip Code:11557-2089
Mailing Address - Country:US
Mailing Address - Phone:516-812-7922
Mailing Address - Fax:
Practice Address - Street 1:1230 BROADWAY
Practice Address - Street 2:APT. 1
Practice Address - City:HEWLETT
Practice Address - State:NY
Practice Address - Zip Code:11557-2089
Practice Address - Country:US
Practice Address - Phone:516-812-7922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY079058-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker