Provider Demographics
NPI:1639155062
Name:GALVAN-HENKIN, ANITA SANDRA (MSW)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:SANDRA
Last Name:GALVAN-HENKIN
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 TODDS WAY
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5645
Mailing Address - Country:US
Mailing Address - Phone:203-255-2680
Mailing Address - Fax:203-255-2602
Practice Address - Street 1:4 TODDS WAY
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5645
Practice Address - Country:US
Practice Address - Phone:203-255-2680
Practice Address - Fax:203-255-2602
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-18
Last Update Date:2010-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT25321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTP2556023OtherOXFORD HEALTH PLANS
CT140002532CT01OtherANTHEM BLUE CROSS BLUE SH
CT140002532CT01OtherANTHEM BLUE CROSS BLUE SH