Provider Demographics
NPI:1912873399
Name:ANNOR ANTWI, STACY-ANN
Entity type:Individual
Prefix:
First Name:STACY-ANN
Middle Name:
Last Name:ANNOR ANTWI
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 1:20 COLONY ST
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:CT
Mailing Address - Zip Code:06418-1230
Mailing Address - Country:US
Mailing Address - Phone:475-777-5905
Mailing Address - Fax:475-777-5909
Practice Address - Street 1:12 PROGRESS DR
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-6290
Practice Address - Country:US
Practice Address - Phone:475-777-5905
Practice Address - Fax:475-777-5909
Is Sole Proprietor?:No
Enumeration Date:2025-10-14
Last Update Date:2025-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist