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General NPI Number Information
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NPI Number | 1871681940
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Entity Type | Individual
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Provider Name | MICHAEL RAYMOND ANTHONY PSY.D.; QME
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Gender | Male
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Dates
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Enumeration Date | 10/11/2006
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Last Update Date | 10/25/2012
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Provider Practice Location Address
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Address Line | 18800 DELAWARE STREET SUITE 400
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648
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Country | US
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Telephone | 714-317-0168
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Fax | 949-281-5268
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Provider Business Mailing Address
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Address Line | 419 MAIN STREET #24
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92648
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Country | US
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Telephone | 714-317-0168
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Fax | 949-281-5268
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | #PSY17717
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 17717
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License Number State | CA
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