Provider Demographics
NPI:1215239660
Name:PRIMUS, ANTHONY HERBERT (LMSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:HERBERT
Last Name:PRIMUS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BAYBERRY DR
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NY
Mailing Address - Zip Code:10950-5607
Mailing Address - Country:US
Mailing Address - Phone:845-783-2167
Mailing Address - Fax:
Practice Address - Street 1:10 KAYLEEN DR
Practice Address - Street 2:
Practice Address - City:NEW WINDSOR
Practice Address - State:NY
Practice Address - Zip Code:12553-7030
Practice Address - Country:US
Practice Address - Phone:845-565-6888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-17
Last Update Date:2010-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070224-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health