Basic Information
Provider Information | |||||||||
NPI: | 1801170808 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | NOTO | ||||||||
FirstName: | ANISSA | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | MISS | ||||||||
NameSuffix: |   | ||||||||
Credential: | LMSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2570 ROUTE 9W STE 10 | ||||||||
Address2: |   | ||||||||
City: | CORNWALL | ||||||||
State: | NY | ||||||||
PostalCode: | 125181370 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8452203100 | ||||||||
FaxNumber: | 8455342940 | ||||||||
Practice Location | |||||||||
Address1: | 91 BLOOMING GROVE TPKE | ||||||||
Address2: |   | ||||||||
City: | NEW WINDSOR | ||||||||
State: | NY | ||||||||
PostalCode: | 125537757 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8452202074 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/10/2011 | ||||||||
LastUpdateDate: | 06/06/2019 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 083631-1 | NY | Y |   | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.