Provider Demographics
NPI:1689942336
Name:DAVENPORT, ANNA CATHERINE (LMFT)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:CATHERINE
Last Name:DAVENPORT
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HIGH ST STE 202
Mailing Address - Street 2:
Mailing Address - City:SUFFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06078-2125
Mailing Address - Country:US
Mailing Address - Phone:860-668-1444
Mailing Address - Fax:860-668-1446
Practice Address - Street 1:11 HIGH ST STE 202
Practice Address - Street 2:
Practice Address - City:SUFFIELD
Practice Address - State:CT
Practice Address - Zip Code:06078-2125
Practice Address - Country:US
Practice Address - Phone:860-668-1444
Practice Address - Fax:860-668-1446
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-09
Last Update Date:2023-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000724106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008038165Medicaid