Provider Demographics
NPI:1902010440
Name:LEUNG, ANNA W (PHD)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:W
Last Name:LEUNG
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 1:5 SOLOMON CT
Mailing Address - Street 2:
Mailing Address - City:WATERVLIET
Mailing Address - State:NY
Mailing Address - Zip Code:12189-1241
Mailing Address - Country:US
Mailing Address - Phone:518-334-6989
Mailing Address - Fax:
Practice Address - Street 1:56 CLIFTON COUNTRY RD STE 100
Practice Address - Street 2:
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-3994
Practice Address - Country:US
Practice Address - Phone:518-334-6989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001743101YM0800X
NY019713103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health