Provider Demographics
NPI:1922122472
Name:VANETTEN, DERITH ELLEN (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:DERITH
Middle Name:ELLEN
Last Name:VANETTEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4656 160TH ST # 2
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11358-3633
Mailing Address - Country:US
Mailing Address - Phone:718-353-1492
Mailing Address - Fax:718-353-1492
Practice Address - Street 1:14210 SANFORD AVE
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2577
Practice Address - Country:US
Practice Address - Phone:718-463-4613
Practice Address - Fax:718-939-9136
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000820-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health