Provider Demographics
NPI:1255094082
Name:FEDERICI, ANTHONY RICHARD (MA, LPC)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:RICHARD
Last Name:FEDERICI
Suffix:
Gender:M
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 E HOLLY AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1197
Mailing Address - Country:US
Mailing Address - Phone:609-420-6849
Mailing Address - Fax:
Practice Address - Street 1:72 E HOLLY AVE STE 107
Practice Address - Street 2:
Practice Address - City:PITMAN
Practice Address - State:NJ
Practice Address - Zip Code:08071-1197
Practice Address - Country:US
Practice Address - Phone:609-420-6849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-19
Last Update Date:2025-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC01102000101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty