Provider Demographics
NPI:1174233746
Name:DZMUROVA, VANESSA
Entity type:Individual
Prefix:
First Name:VANESSA
Middle Name:
Last Name:DZMUROVA
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:STECHOVICKA 3468/2
Mailing Address - Street 2:APT B-201
Mailing Address - City:PRAGUE
Mailing Address - State:CZECH REPUBLIC
Mailing Address - Zip Code:100 00
Mailing Address - Country:CZ
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:41 UNION SQ W STE 1328
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-3252
Practice Address - Country:US
Practice Address - Phone:516-382-5440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-05
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1366012551OtherGROUP NPI