=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598123846
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ANTHONY GAUDIOSO, PHD, LMHC , PC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2016
-----------------------------------------------------
Last Update Date | 08/02/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 79 SAINT JAMES ST SECOND FLOOR
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-470-9224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 79 SAINT JAMES ST SECOND FLOOR
-----------------------------------------------------
City | KINGSTON
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 12401-4513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-470-9224
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL COUNSELOR
-----------------------------------------------------
Name | DR. ANTHONY GUADIOSO
-----------------------------------------------------
Credential | LMHC, PHD
-----------------------------------------------------
Telephone | 917-470-9224
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | P99440
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------