Provider Demographics
NPI:1275549123
Name:ANDERSON, KRISSA ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KRISSA
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:KRISSA
Other - Middle Name:ANN
Other - Last Name:SOBOLESKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:25 CROFT COURT
Mailing Address - Street 2:
Mailing Address - City:PAWCATUCK
Mailing Address - State:CT
Mailing Address - Zip Code:06379
Mailing Address - Country:US
Mailing Address - Phone:860-599-1132
Mailing Address - Fax:
Practice Address - Street 1:130 SHENNECOSSETT ROAD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340
Practice Address - Country:US
Practice Address - Phone:860-445-2191
Practice Address - Fax:860-445-2191
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT005647CT011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical