Provider Demographics
NPI:1073278735
Name:BIRCHENOUGH, ANNA MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:MARIE
Last Name:BIRCHENOUGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:59 BURNING TREE RD
Mailing Address - Street 2:
Mailing Address - City:GREENWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06830-3505
Mailing Address - Country:US
Mailing Address - Phone:203-609-1679
Mailing Address - Fax:
Practice Address - Street 1:59 BURNING TREE RD
Practice Address - Street 2:
Practice Address - City:GREENWICH
Practice Address - State:CT
Practice Address - Zip Code:06830-3505
Practice Address - Country:US
Practice Address - Phone:203-609-1679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-07
Last Update Date:2021-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT11797102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst