Provider Demographics
NPI:1306236153
Name:SMALL, ANNA MARIE
Entity type:Individual
Prefix:
First Name:ANNA MARIE
Middle Name:
Last Name:SMALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANNA MARIE
Other - Middle Name:
Other - Last Name:SMALL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CNS
Mailing Address - Street 1:7-11 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-3531
Mailing Address - Country:US
Mailing Address - Phone:914-552-3294
Mailing Address - Fax:
Practice Address - Street 1:7-11 S BROADWAY
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-3531
Practice Address - Country:US
Practice Address - Phone:914-552-3294
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYM188437101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional