Provider Demographics
NPI:1821287913
Name:DEMIERI, ANTHONY RAYMOND
Entity Type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RAYMOND
Last Name:DEMIERI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10455-4029
Mailing Address - Country:US
Mailing Address - Phone:718-665-2456
Mailing Address - Fax:718-665-1174
Practice Address - Street 1:2780 3RD AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10455
Practice Address - Country:US
Practice Address - Phone:718-665-2456
Practice Address - Fax:718-665-1174
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2019-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT104691041C0700X
104100000X
NY0871021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker