Provider Demographics
NPI:1790200798
Name:DZIECHOWSKI, ANNA (MT-BC, LCAT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:DZIECHOWSKI
Suffix:
Gender:F
Credentials:MT-BC, LCAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 COURT ST STE 2402
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11242-1124
Mailing Address - Country:US
Mailing Address - Phone:732-638-9635
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 2402
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1124
Practice Address - Country:US
Practice Address - Phone:732-638-9635
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-10
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY12127101YM0800X
NY002210225A00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225A00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMusic Therapist