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General NPI Number Information
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NPI Number | 1801108535
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Entity Type | Individual
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Provider Name | JOHN C. ANDERSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/10/2010
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Last Update Date | 07/10/2010
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Provider Practice Location Address
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Address Line | 83-35 139TH STREET UNIT 2D
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 718-575-0926
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Fax | 212-979-1359
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Provider Business Mailing Address
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Address Line | 83-35 139TH STREET UNIT 2D
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City | BRIARWOOD
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State | NY
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Zip | 11435
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Country | US
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Telephone | 718-575-0926
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Fax | 212-979-1359
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | R023968-1
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License Number State | NY
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