Healthcare Provider Details

I. General information

NPI: 1508575101
Provider Name (Legal Business Name): ANNA TSEYTLINA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/22/2022
Last Update Date: 11/22/2022
Certification Date: 11/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 FARVIEW TER STE 1
PARAMUS NJ
07652-2762
US

IV. Provider business mailing address

15 FARVIEW TER STE 1
PARAMUS NJ
07652-2762
US

V. Phone/Fax

Practice location:
  • Phone: 551-579-4441
  • Fax:
Mailing address:
  • Phone: 551-579-4441
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FA00032400
License Number StateNJ

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: