Healthcare Provider Details

I. General information

NPI: 1245051192
Provider Name (Legal Business Name): ANEESHA ALLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 11/07/2024
Certification Date: 11/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1990 LEXINGTON AVE APT 26E
NEW YORK NY
10035-2918
US

IV. Provider business mailing address

4408 CLARENDON RD
BROOKLYN NY
11203-5216
US

V. Phone/Fax

Practice location:
  • Phone: 917-740-9574
  • Fax:
Mailing address:
  • Phone: 347-387-4741
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberP128027
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: