Provider Demographics
NPI:1710047782
Name:ANDERSON, JOHN ALDEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALDEN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CHAPEL ST # B
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-6919
Mailing Address - Country:US
Mailing Address - Phone:203-773-0487
Mailing Address - Fax:
Practice Address - Street 1:621 CHAPEL ST # B
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-6919
Practice Address - Country:US
Practice Address - Phone:203-773-0487
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-11
Last Update Date:2007-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1211103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral