Provider Demographics
NPI:1457900854
Name:PADILLA, ANEESA LEA
Entity Type:Individual
Prefix:
First Name:ANEESA
Middle Name:LEA
Last Name:PADILLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 FIELD ROAD
Mailing Address - Street 2:PO BOX 386
Mailing Address - City:SOMERS
Mailing Address - State:CT
Mailing Address - Zip Code:06071
Mailing Address - Country:US
Mailing Address - Phone:860-593-4862
Mailing Address - Fax:
Practice Address - Street 1:476 APPLETON ST STE 5
Practice Address - Street 2:
Practice Address - City:HOLYOKE
Practice Address - State:MA
Practice Address - Zip Code:01040-3236
Practice Address - Country:US
Practice Address - Phone:860-593-4862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT002418556Medicaid