Provider Demographics
NPI:1689838963
Name:WEICHT, ANITA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:WEICHT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 POOL RD
Mailing Address - Street 2:
Mailing Address - City:NORTH HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06473-2312
Mailing Address - Country:US
Mailing Address - Phone:203-988-5192
Mailing Address - Fax:
Practice Address - Street 1:1062 BARNES RD
Practice Address - Street 2:SUITE 106
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-6012
Practice Address - Country:US
Practice Address - Phone:203-988-5192
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2013-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT004245104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004243010Medicaid
CT004243010Medicaid