Provider Demographics
NPI:1760249981
Name:NEAK, ANTHONY (EDS)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:NEAK
Suffix:
Gender:M
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 BRENTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BUSHKILL
Mailing Address - State:PA
Mailing Address - Zip Code:18324-7733
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:156 BRENTWOOD DR
Practice Address - Street 2:
Practice Address - City:BUSHKILL
Practice Address - State:PA
Practice Address - Zip Code:18324-7733
Practice Address - Country:US
Practice Address - Phone:570-994-7013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-04
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL2485575103TS0200X
WA568427R103TS0200X
PA1921359103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool