Provider Demographics
NPI:1962030858
Name:TALIERCIO, ANISA K
Entity Type:Individual
Prefix:
First Name:ANISA
Middle Name:K
Last Name:TALIERCIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANISA
Other - Middle Name:K
Other - Last Name:NIEVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 TRIANGLE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06855-1627
Mailing Address - Country:US
Mailing Address - Phone:203-814-2783
Mailing Address - Fax:
Practice Address - Street 1:350 CENTER ROCK GRN STE 9
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:CT
Practice Address - Zip Code:06478-3170
Practice Address - Country:US
Practice Address - Phone:203-951-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-28
Last Update Date:2020-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT4037104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT4037OtherMASTER LEVEL SOCIAL WORKER LICENSE