Provider Demographics
NPI:1932668589
Name:ANDERSON, ERIC MATTHEW (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:MATTHEW
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 EATON ST
Mailing Address - Street 2:
Mailing Address - City:OAKVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06779-1216
Mailing Address - Country:US
Mailing Address - Phone:860-777-7317
Mailing Address - Fax:
Practice Address - Street 1:62 EATON ST
Practice Address - Street 2:
Practice Address - City:OAKVILLE
Practice Address - State:CT
Practice Address - Zip Code:06779-1216
Practice Address - Country:US
Practice Address - Phone:860-777-7317
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-13
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1321101YA0400X
CT5198101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)