Provider Demographics
NPI:1003282674
Name:LOITERSTEIN, ANNA
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:LOITERSTEIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 YORK ST
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-2473
Mailing Address - Country:US
Mailing Address - Phone:203-453-2220
Mailing Address - Fax:
Practice Address - Street 1:34 YORK ST
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-2473
Practice Address - Country:US
Practice Address - Phone:203-453-2220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-18
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY141397918Medicaid