Individual
ANN DEITERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1351 WASHINGTON BLVD, STAMFORD, CT 06902-2419
(203) 621-3700
(203) 621-3710
Mailing address
590 POST RD, DARIEN, CT 06820-3608
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004234788
—
CT
01
—
403
STATE LICENSE
CT
Enumeration date
07/07/2008
Last updated
01/23/2015
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