Healthcare Provider Details

I. General information

NPI: 1205742822
Provider Name (Legal Business Name): ANI BUK PSYCHOTHERAPY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2026
Last Update Date: 08/22/2026
Certification Date: 08/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47 JUDSON AVE
WOODBURY CT
06798-2830
US

IV. Provider business mailing address

47 JUDSON AVE
WOODBURY CT
06798-2830
US

V. Phone/Fax

Practice location:
  • Phone: 212-560-5556
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number
License Number State

VIII. Authorized Official

Name: ANI BUK
Title or Position: MEMBER
Credential:
Phone: 212-560-5556