Provider Demographics
NPI:1699015081
Name:TSANGARIDES, LIANNA
Entity Type:Individual
Prefix:
First Name:LIANNA
Middle Name:
Last Name:TSANGARIDES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LIANNA
Other - Middle Name:
Other - Last Name:TSANGARIDES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27 SIEMON COMPANY DR
Mailing Address - Street 2:BOX 8B
Mailing Address - City:WATERTOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06795-2654
Mailing Address - Country:US
Mailing Address - Phone:860-387-5689
Mailing Address - Fax:860-201-4314
Practice Address - Street 1:27 SIEMON COMPANY DR
Practice Address - Street 2:SUITE 238W
Practice Address - City:WATERTOWN
Practice Address - State:CT
Practice Address - Zip Code:06795-2654
Practice Address - Country:US
Practice Address - Phone:860-387-5689
Practice Address - Fax:860-201-4314
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-21
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0071221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008063518Medicaid