Provider Demographics
NPI:1194831198
Name:MCNEELY, ADRIANE IRIS (MFT)
Entity Type:Individual
Prefix:
First Name:ADRIANE
Middle Name:IRIS
Last Name:MCNEELY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1653 CAPITOL AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06604-1525
Mailing Address - Country:US
Mailing Address - Phone:203-913-8115
Mailing Address - Fax:
Practice Address - Street 1:1653 CAPITOL AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-1525
Practice Address - Country:US
Practice Address - Phone:203-913-8115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT001020106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2979719OtherOXFORD HEALTH
CT410001020CT01OtherANTHEM BLUE CROSS
CT305034OtherHEALTHNET