Provider Demographics
NPI:1003845546
Name:VANDERMAELEN, ANN LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:LOUISE
Last Name:VANDERMAELEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 OLDE ORCHARD RD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:CT
Mailing Address - Zip Code:06413-1100
Mailing Address - Country:US
Mailing Address - Phone:860-669-3466
Mailing Address - Fax:
Practice Address - Street 1:191 MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-2332
Practice Address - Country:US
Practice Address - Phone:860-388-3844
Practice Address - Fax:860-388-1689
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000901103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical