Provider Demographics
NPI:1841361185
Name:PROVET, ANNE GERSONY (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNE
Middle Name:GERSONY
Last Name:PROVET
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:LYN
Other - Last Name:GERSONY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:163 GREAT OAK LANE
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570
Mailing Address - Country:US
Mailing Address - Phone:914-773-7004
Mailing Address - Fax:914-747-9285
Practice Address - Street 1:NYMC BEHAVIORAL HEALTH CENTER,
Practice Address - Street 2:N326
Practice Address - City:VALHALLA
Practice Address - State:NY
Practice Address - Zip Code:10595
Practice Address - Country:US
Practice Address - Phone:914-493-7124
Practice Address - Fax:914-493-1015
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2009-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011832103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02976658Medicaid
NY02976658Medicaid