Anne Marie Vick, R-DMT

Primary specialty

Dance TherapistTaxonomy code 225600000X

License

P107084 Issued in NY

Practice address

483 Clermont Ave
Brooklyn, NY 11238-2253

Phone

(718) 643-5300

NPI assigned

Oct 1, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• League School

  • Early Intervention Provider Agency
  • Brooklyn, NY
  • NPI 1851011357
  NPD

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

{
    "created_epoch": "1601510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1601510400000",
    "number": "1720685878",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "483 CLERMONT AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112382253",
            "telephone_number": "718-643-5300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "483 CLERMONT AVE",
            "city": "BROOKLYN",
            "state": "NY",
            "postal_code": "112382253",
            "telephone_number": "718-643-5300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICK",
        "first_name": "ANNE",
        "middle_name": "MARIE",
        "credential": "R-DMT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-10-01",
        "last_updated": "2020-10-01",
        "certification_date": "2020-10-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "225600000X",
            "taxonomy_group": "",
            "desc": "Dance Therapist",
            "state": "NY",
            "license": "P107084",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P107084",
            "state": "NY"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.leaguecenter.org",
            "affiliation": "N",
            "address_1": "483 Clermont Ave",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112382253",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "avick@leaguecenter.org",
            "affiliation": "N",
            "endpointDescription": "League Education and Treatment Center",
            "address_1": "483 Clermont Ave",
            "city": "Brooklyn",
            "state": "NY",
            "country_code": "US",
            "postal_code": "112382253",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Vichris Medical Supply
• Christina Vicidomini
• Stacey Viciere
• Jenny M Vicioso
• Rachel Vicioso
• Asiya Vickers
• Daynesha Vicks
• Vicky Mesrie Psychology, PLLC
• Vicky Mesrie, LLC
• Vicram Pharmacy Inc (Royal Pharmacy)

• Dance Therapist in Brooklyn, NY
• Providers in Brooklyn, NY by specialty
• Dance Therapist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 1, 2020; 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.