Provider Demographics
NPI:1790071348
Name:BISHOP, ANN-MARIE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ANN-MARIE
Middle Name:
Last Name:BISHOP
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 1:1256 AVON BLVD
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-3606
Mailing Address - Country:US
Mailing Address - Phone:203-535-9168
Mailing Address - Fax:203-271-6626
Practice Address - Street 1:1256 AVON BLVD
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-3606
Practice Address - Country:US
Practice Address - Phone:203-535-9168
Practice Address - Fax:203-271-6626
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-22
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0076361041C0700X
CTC0720100008211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool