Provider Demographics
NPI:1134719271
Name:JANSSEN, ANIKA (LMSW)
Entity type:Individual
Prefix:
First Name:ANIKA
Middle Name:
Last Name:JANSSEN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 LONG ST
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1710
Mailing Address - Country:US
Mailing Address - Phone:631-466-8213
Mailing Address - Fax:
Practice Address - Street 1:606 JOHNSON AVE STE 34
Practice Address - Street 2:
Practice Address - City:BOHEMIA
Practice Address - State:NY
Practice Address - Zip Code:11716-2689
Practice Address - Country:US
Practice Address - Phone:631-503-1539
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-22
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker