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Individual

ANNA ICTCHENKO

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PMHNP-BC

Contact information

Practice address
34 MANCHESTER AVE STE 202, FORKED RIVER, NJ 08731-1366
(973) 954-4592
(973) 954-4592
Mailing address
1 UNIVERSITY PLZ STE 408, HACKENSACK, NJ 07601-6204
(973) 954-4592
(973) 954-4592

Taxonomy

Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
26NJ15261500
NJ

Other

Enumeration date
01/02/2025
Last updated
09/26/2025
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