Basic Information
| Provider Information | |||||||||
| NPI: | 1699239152 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANTHONY ANNUNZIATA, PHD, LLC | ||||||||
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| OtherOrganizationName: | ANTHONY ANNUNZIATA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 271 MAIN ST | ||||||||
| Address2: | STE 205 | ||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021803580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814385550 | ||||||||
| FaxNumber: | 7814385553 | ||||||||
| Practice Location | |||||||||
| Address1: | 271 MAIN ST STE 205 | ||||||||
| Address2: | |||||||||
| City: | STONEHAM | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021803580 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7814385550 | ||||||||
| FaxNumber: | 7814385553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2019 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| AuthorizedOfficialLastName: | ANNUNZIATA | ||||||||
| AuthorizedOfficialFirstName: | ANTHONY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CLINICAL PSYCHOLOGIST | ||||||||
| AuthorizedOfficialTelephone: | 7814385550 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | PHD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.