Healthcare Provider Details

I. General information

NPI: 1164538112
Provider Name (Legal Business Name): ANITA WEICHT, LCSW, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 07/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 CHURCH ST RT 68
YALESVILLE CT
06492
US

IV. Provider business mailing address

91 POOL ROAD
NORTH HAVEN CT
06473
US

V. Phone/Fax

Practice location:
  • Phone: 203-265-7770
  • Fax: 203-239-1422
Mailing address:
  • Phone: 203-265-7770
  • Fax: 203-239-1422

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number004245
License Number StateCT

VIII. Authorized Official

Name: MS. ANITA CATHERINE WEICHT
Title or Position: CLINICAL SOCIAL WORKER
Credential: LCSW
Phone: 203-239-1422