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General NPI Number Information
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NPI Number | 1689767741
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Entity Type | Individual
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Provider Name | ANYA GENIESER-DEROSA PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 80 GRAVEL PIKE UNIT B
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City | RED HILL
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State | PA
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Zip | 18076-1428
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Country | US
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Telephone | 484-624-2415
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Fax | 215-679-2875
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Provider Business Mailing Address
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Address Line | 1848 CANDLEWYCK LN
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City | GREEN LANE
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State | PA
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Zip | 18054-2047
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Country | US
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Telephone | 484-624-2415
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Fax | 215-679-2875
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TB0200X
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Taxonomy Name | Cognitive & Behavioral Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PS015501
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC2200X
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Taxonomy Name | Clinical Child & Adolescent Psychologist
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS015501
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License Number State | PA
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