Provider Demographics
NPI:1699490763
Name:JONGAY-HUDSON, ANISHA NICOLE
Entity type:Individual
Prefix:
First Name:ANISHA
Middle Name:NICOLE
Last Name:JONGAY-HUDSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1991 NORTHAMPTON ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18042-3173
Mailing Address - Country:US
Mailing Address - Phone:570-446-1025
Mailing Address - Fax:
Practice Address - Street 1:3104 SEQUOIA RD
Practice Address - Street 2:
Practice Address - City:TOBYHANNA
Practice Address - State:PA
Practice Address - Zip Code:18466-8083
Practice Address - Country:US
Practice Address - Phone:516-413-1337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY616487972106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician