Provider Demographics
NPI:1124338017
Name:DEUTSCH-ANZALONE, VERONIQUE REGINA (PSYD)
Entity type:Individual
Prefix:DR
First Name:VERONIQUE
Middle Name:REGINA
Last Name:DEUTSCH-ANZALONE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 NICOLLS RD DEPT OF
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11794-0012
Mailing Address - Country:US
Mailing Address - Phone:631-632-2428
Mailing Address - Fax:
Practice Address - Street 1:100 NICOLLS RD DEPT OF
Practice Address - Street 2:
Practice Address - City:STONY BROOK
Practice Address - State:NY
Practice Address - Zip Code:11794-0012
Practice Address - Country:US
Practice Address - Phone:631-632-2428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-14
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019480103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical