Healthcare Provider Details

I. General information

NPI: 1144167404
Provider Name (Legal Business Name): VAN ANH NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MIA NGUYEN

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 HALLETTS PT
ASTORIA NY
11102-5082
US

IV. Provider business mailing address

20 HALLETTS PT APT 512
ASTORIA NY
11102-5088
US

V. Phone/Fax

Practice location:
  • Phone: 347-712-9833
  • Fax:
Mailing address:
  • Phone: 347-712-9833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: