Provider Demographics
NPI:1821483108
Name:ELMORE, ALLIETA (LCAS-A)
Entity Type:Individual
Prefix:
First Name:ALLIETA
Middle Name:
Last Name:ELMORE
Suffix:
Gender:F
Credentials:LCAS-A
Other - Prefix:
Other - First Name:ALLIETA
Other - Middle Name:
Other - Last Name:ANDERSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1 LONG WHARF DR
Mailing Address - Street 2:SUITE 321
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-5991
Mailing Address - Country:US
Mailing Address - Phone:203-781-4600
Mailing Address - Fax:203-781-4624
Practice Address - Street 1:54 E RAMSDELL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1140
Practice Address - Country:US
Practice Address - Phone:203-337-9943
Practice Address - Fax:203-387-6533
Is Sole Proprietor?:No
Enumeration Date:2015-04-02
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1127101YA0400X
NC26985101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008023170Medicaid
CT008024427Medicaid
CT008039745Medicaid
CT008058232OtherANDERSON MEDICAID