Provider Demographics
NPI:1902412836
Name:ANELLO, JAMES (LADCII)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:
Last Name:ANELLO
Suffix:
Gender:M
Credentials:LADCII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 GRAHAM ST
Mailing Address - Street 2:
Mailing Address - City:GARDNER
Mailing Address - State:MA
Mailing Address - Zip Code:01440-3847
Mailing Address - Country:US
Mailing Address - Phone:978-632-4574
Mailing Address - Fax:
Practice Address - Street 1:171 GRAHAM ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3847
Practice Address - Country:US
Practice Address - Phone:978-632-4574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-16
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA16660101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)