Healthcare Provider Details

I. General information

NPI: 1134719271
Provider Name (Legal Business Name): ANIKA JANSSEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2021
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 JOHNSON AVE STE 34
BOHEMIA NY
11716-2689
US

IV. Provider business mailing address

6 LONG ST
LAKE GROVE NY
11755-1710
US

V. Phone/Fax

Practice location:
  • Phone: 631-503-1539
  • Fax:
Mailing address:
  • Phone: 631-466-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

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: