MEDICARE: DR. ANITA JOSE PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	019358	NY

General Provider Information

NPI Number	:	1255615589
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ANITA JOSE PH.D.

Provider Business Mailing Address
First Line	:	334 E 148TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5707
Country	:	US
Telephone Number	:	718-401-5050
Fax Number	:	718-401-5080

Provider Business Practice Location Address
First Line	:	334 E 148TH ST
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-5707
Country	:	US
Telephone Number	:	718-401-5050
Fax Number	:	718-401-5080

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2011
Last Update Date	:	10/27/2011

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