Provider Demographics
NPI:1215445614
Name:ANEXAGOROU, PAULA (LCSW)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:
Last Name:ANEXAGOROU
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 AUSTIN ST.
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-1022
Mailing Address - Country:US
Mailing Address - Phone:718-762-7633
Mailing Address - Fax:
Practice Address - Street 1:7000 AUSTIN ST.
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-1022
Practice Address - Country:US
Practice Address - Phone:718-762-7633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-19
Last Update Date:2019-03-29
Deactivation Date:2019-03-05
Deactivation Code:
Reactivation Date:2019-03-29
Provider Licenses
StateLicense IDTaxonomies
NY0863441041C0700X
252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical