MEDICARE: ANISSA B UNDERWOOD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1629716535
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANISSA B UNDERWOOD

Provider Business Mailing Address
First Line	:	339 RACE ST APT A1
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18301-1226
Country	:	US
Telephone Number	:	570-422-6522
Fax Number	:

Provider Business Practice Location Address
First Line	:	5221 MILFORD RD
Second Line	:
City	:	EAST STROUDSBURG
State	:	PA
Zip	:	18302-9149
Country	:	US
Telephone Number	:	570-422-6522
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2022
Last Update Date	:	05/23/2022

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Directions to “ ANISSA B UNDERWOOD ” Practice Location

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