Provider Demographics
NPI:1295283661
Name:ANICETO, ANA
Entity type:Individual
Prefix:
First Name:ANA
Middle Name:
Last Name:ANICETO
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 1:10827 42ND AVE
Mailing Address - Street 2:FL1
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2532
Mailing Address - Country:US
Mailing Address - Phone:917-573-3800
Mailing Address - Fax:
Practice Address - Street 1:91-14 37TH AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372
Practice Address - Country:US
Practice Address - Phone:718-779-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker