Provider Demographics
NPI:1023291499
Name:CARON, ANNALISE LAWLER (PHD)
Entity type:Individual
Prefix:DR
First Name:ANNALISE
Middle Name:LAWLER
Last Name:CARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 POST RD E STE 223
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06880-5643
Mailing Address - Country:US
Mailing Address - Phone:203-220-6486
Mailing Address - Fax:203-220-6487
Practice Address - Street 1:1720 POST RD E STE 223
Practice Address - Street 2:
Practice Address - City:WESTPORT
Practice Address - State:CT
Practice Address - Zip Code:06880-5643
Practice Address - Country:US
Practice Address - Phone:203-220-6486
Practice Address - Fax:203-220-6487
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-08
Last Update Date:2013-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017010103TB0200X, 103TC0700X, 103TC2200X
CT3085103TC2200X, 103TC0700X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent