=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285845412
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DANIA FELLER ANDERSON LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2007
-----------------------------------------------------
Last Update Date | 08/08/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 55 E 86TH ST SUITE 1-A RETINA GROUP
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10028-1059
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-575-3674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 RICHMOND HILL RD
-----------------------------------------------------
City | WESTON
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06883-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-575-3674
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | R052155-1
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------