Healthcare Provider Details

I. General information

NPI: 1780974881
Provider Name (Legal Business Name): ANELLYSE L BOEBEL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

91 NORTHWEST DR
PLAINVILLE CT
06062-1534
US

IV. Provider business mailing address

97 DAVIS DR
BRISTOL CT
06010-3768
US

V. Phone/Fax

Practice location:
  • Phone: 888-793-3500
  • Fax: 860-793-3520
Mailing address:
  • Phone: 860-518-1599
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number097450740
License Number StateCT

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: