Provider Demographics
NPI:1457893323
Name:BRIGHT, VANESSA HANNAH (LP)
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:HANNAH
Last Name:BRIGHT
Suffix:
Gender:F
Credentials:LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29 W 36TH ST STE 5Q
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-7907
Mailing Address - Country:US
Mailing Address - Phone:646-801-2799
Mailing Address - Fax:
Practice Address - Street 1:215 N GENEVA ST STE 2
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4166
Practice Address - Country:US
Practice Address - Phone:646-801-2799
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-09
Last Update Date:2019-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000978-1102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst