Healthcare Provider Details

I. General information

NPI: 1326475187
Provider Name (Legal Business Name): ANNA VENEZIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18730 GRAND CENTRAL PKWY
JAMAICA NY
11432-5819
US

IV. Provider business mailing address

18730 GRAND CENTRAL PKWY
JAMAICA NY
11432-5819
US

V. Phone/Fax

Practice location:
  • Phone: 718-264-2931
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1293955
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: