Provider Demographics
NPI:1598992729
Name:ANZIANO, KELLY S (LADC)
Entity Type:Individual
Prefix:
First Name:KELLY
Middle Name:S
Last Name:ANZIANO
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1728
Mailing Address - Country:US
Mailing Address - Phone:860-229-4830
Mailing Address - Fax:860-826-8701
Practice Address - Street 1:10 WHITING ST
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06051-3113
Practice Address - Country:US
Practice Address - Phone:860-229-4830
Practice Address - Fax:860-826-8701
Is Sole Proprietor?:No
Enumeration Date:2009-06-15
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000785101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)