Basic Information
| Provider Information | |||||||||
| NPI: | 1215445614 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ANEXAGOROU | ||||||||
| FirstName: | PAULA | ||||||||
| MiddleName: | |||||||||
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| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 AUSTIN ST. | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113751022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 7000 AUSTIN ST. | ||||||||
| Address2: | |||||||||
| City: | FOREST HILLS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113751022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7187627633 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2018 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | 03/05/2019 | ||||||||
| NPIReactivationDate: | 03/29/2019 | ||||||||
| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 086344 | NY | N | Behavioral Health & Social Service Providers | Social Worker | Clinical | 252Y00000X | Y | Agencies | Early Intervention Provider Agency |
No ID Information.