Provider Demographics
NPI:1780042440
Name:ANGUS, ANEEKA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANEEKA
Middle Name:
Last Name:ANGUS
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 1:90 COURT ST STE 203
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457-3334
Mailing Address - Country:US
Mailing Address - Phone:203-592-7934
Mailing Address - Fax:
Practice Address - Street 1:90 COURT ST STE 203
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3334
Practice Address - Country:US
Practice Address - Phone:203-592-7934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-09
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT84851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040564Medicaid