Provider Demographics
NPI:1154552883
Name:NICHOLAIDES, ANNA HIATT (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANNA
Middle Name:HIATT
Last Name:NICHOLAIDES
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 1:1420 WALNUT ST
Mailing Address - Street 2:SUITE 1010
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19102-4017
Mailing Address - Country:US
Mailing Address - Phone:267-702-6623
Mailing Address - Fax:
Practice Address - Street 1:1420 WALNUT ST
Practice Address - Street 2:SUITE 1010
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19102-4017
Practice Address - Country:US
Practice Address - Phone:267-702-6623
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-29
Last Update Date:2017-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016827103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical