Individual provider Active NPI

Christine Anzieu-Premmereur, PHD

  • Clinical Child & Adolescent Psychologist
  • New York, NY
National Provider Identifier
1679796171
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Child & Adolescent PsychologistTaxonomy code 103TC2200X
License
015496-1 Issued in NY
Practice address
30 E 95TH St Apt 1B
New York, NY 10128-0721
Phone
(212) 828-8422
Fax
(212) 996-7618
NPI assigned
Apr 11, 2007
Last updated
Jul 8, 2007By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Child & Adolescent Psychologist 103TC2200X 015496-1 NY Primary

Addresses

Primary practice location

30 E 95TH St Apt 1B
New York, NY 10128-0721

Mailing address

200 E 94TH St Apt 3012
New York, NY 10128-3915
Phone (212) 996-1109

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
015496-1NYMDClinical Child & Adolescent Psychologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679796171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "200 E 94TH ST APT 3012",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101283915",
            "telephone_number": "212-996-1109",
            "fax_number": "212-996-7618"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "30 E 95TH ST APT 1B",
            "city": "NEW YORK",
            "state": "NY",
            "postal_code": "101280721",
            "telephone_number": "212-828-8422",
            "fax_number": "212-996-7618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANZIEU-PREMMEREUR",
        "first_name": "CHRISTINE",
        "name_prefix": "Mrs.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-04-11",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "NY",
            "license": "015496-1",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in New York, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.