Provider Demographics
NPI:1982827739
Name:ANIEBONA, JEAN LOUISE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JEAN
Middle Name:LOUISE
Last Name:ANIEBONA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 E 15TH ST
Mailing Address - Street 2:8L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003-3922
Mailing Address - Country:US
Mailing Address - Phone:212-475-8458
Mailing Address - Fax:212-475-9218
Practice Address - Street 1:210 E 15TH ST
Practice Address - Street 2:8L
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3922
Practice Address - Country:US
Practice Address - Phone:212-475-8458
Practice Address - Fax:212-475-9218
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR018925-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN14471Medicare ID - Type Unspecified