Provider Demographics
NPI:1851680417
Name:THANASIU, PAGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:PAGE
Middle Name:
Last Name:THANASIU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 LUNA BELLA LN
Mailing Address - Street 2:
Mailing Address - City:NEW SMYRNA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32168-5347
Mailing Address - Country:US
Mailing Address - Phone:386-235-5462
Mailing Address - Fax:
Practice Address - Street 1:453 LUNA BELLA LN
Practice Address - Street 2:
Practice Address - City:NEW SMYRNA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32168-5347
Practice Address - Country:US
Practice Address - Phone:386-235-5462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-05
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH9257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health