Provider Demographics
NPI:1306107974
Name:SURNITSKY, ANYA (LCSW)
Entity type:Individual
Prefix:
First Name:ANYA
Middle Name:
Last Name:SURNITSKY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANYA
Other - Middle Name:
Other - Last Name:GOLDBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:5200 IVYSTREAM RD
Mailing Address - Street 2:
Mailing Address - City:HATBORO
Mailing Address - State:PA
Mailing Address - Zip Code:19040-3012
Mailing Address - Country:US
Mailing Address - Phone:267-209-0795
Mailing Address - Fax:
Practice Address - Street 1:1025 EASTON RD
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-2023
Practice Address - Country:US
Practice Address - Phone:267-209-0795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0171601041C0700X
CW0171601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical