Provider Demographics
NPI:1700535101
Name:PENROSA, ANNE LANFORD (BCBA)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:LANFORD
Last Name:PENROSA
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 SYLVAN AVE STE 1110
Mailing Address - Street 2:
Mailing Address - City:ENGLEWOOD CLIFFS
Mailing Address - State:NJ
Mailing Address - Zip Code:07632-3118
Mailing Address - Country:US
Mailing Address - Phone:646-873-6600
Mailing Address - Fax:646-859-4440
Practice Address - Street 1:10475 CROSSPOINT BLVD STE 250
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-3387
Practice Address - Country:US
Practice Address - Phone:463-205-0087
Practice Address - Fax:646-859-4440
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-22
Last Update Date:2022-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1-21-56592103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst