Healthcare Provider Details

I. General information

NPI: 1407556780
Provider Name (Legal Business Name): ANNA SIMIDIAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/06/2023
Last Update Date: 01/05/2026
Certification Date: 01/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

117 DOBBIN ST STE 204A
BROOKLYN NY
11222-2803
US

IV. Provider business mailing address

2515 36TH ST APT 2F
ASTORIA NY
11103-5197
US

V. Phone/Fax

Practice location:
  • Phone: 347-255-1747
  • Fax:
Mailing address:
  • Phone: 347-623-9936
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number017278
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberP120457
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: