Provider Demographics
NPI:1467503862
Name:ANDERSON-DECELLES, NEILA A (MA)
Entity Type:Individual
Prefix:
First Name:NEILA
Middle Name:A
Last Name:ANDERSON-DECELLES
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SIAS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:VT
Mailing Address - Zip Code:05855-5865
Mailing Address - Country:US
Mailing Address - Phone:802-334-3178
Mailing Address - Fax:
Practice Address - Street 1:215 GLEN RD
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-9777
Practice Address - Country:US
Practice Address - Phone:802-334-7578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0470000727103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical