Provider Demographics
NPI:1285490672
Name:DEROSA, ANNA PATRICIA (LMSW)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:PATRICIA
Last Name:DEROSA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ANNA
Other - Middle Name:P
Other - Last Name:DEROSA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:354 VETERANS MEMORIAL HWY STE 5
Mailing Address - Street 2:
Mailing Address - City:COMMACK
Mailing Address - State:NY
Mailing Address - Zip Code:11725-4331
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:354 VETERANS MEMORIAL HWY STE 5
Practice Address - Street 2:
Practice Address - City:COMMACK
Practice Address - State:NY
Practice Address - Zip Code:11725-4331
Practice Address - Country:US
Practice Address - Phone:631-600-3216
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
122689-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker