1164538112 NPI number — ANITA WEICHT, LCSW, LLC

Table of content: (NPI 1164538112)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164538112 NPI number — ANITA WEICHT, LCSW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANITA WEICHT, LCSW, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164538112
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91 POOL ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH HAVEN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06473
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-265-7770
Provider Business Mailing Address Fax Number:
203-239-1422

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 CHURCH ST RT 68
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YALESVILLE
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06492
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-265-7770
Provider Business Practice Location Address Fax Number:
203-239-1422
Provider Enumeration Date:
08/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WEICHT
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
CATHERINE
Authorized Official Title or Position:
CLINICAL SOCIAL WORKER
Authorized Official Telephone Number:
203-239-1422

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  004245 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004243010 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".