Provider Demographics
NPI:1265918379
Name:JOSEPHSON, ANNE
Entity type:Individual
Prefix:
First Name:ANNE
Middle Name:
Last Name:JOSEPHSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E 67TH ST STE 1D
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10065-5831
Mailing Address - Country:US
Mailing Address - Phone:646-389-6645
Mailing Address - Fax:
Practice Address - Street 1:17 E 67TH ST STE 1D
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10065-5831
Practice Address - Country:US
Practice Address - Phone:646-389-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TB0200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program