Individual
DIANA ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
495 CONGRESS AVE, NEW HAVEN, CT 06519
(032) 285-2678
(203) 781-4654
Mailing address
1 LONG WHARF DR, NEW HAVEN, CT 06511-5991
(203) 781-4600
(203) 781-4624
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
3457
CT
101YP2500X
Professional Counselor
Primary
3457
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004082260
—
CT
05
—
008001325
—
CT
05
—
008022622
—
CT
05
—
008080804
—
CT
Enumeration date
06/12/2012
Last updated
07/27/2018
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