Individual
DR. RONALD DOUGLAS ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
21 CHURCH ST, WILLIMANTIC, CT 06226-2644
(860) 456-4442
Mailing address
PO BOX 301, MANSFIELD CENTER, CT 06250-0301
(860) 487-1641
(860) 456-4068
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
001296
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0600001296CT03
ANTHEM /BLUE CROSS
CT
Enumeration date
06/16/2005
Last updated
07/08/2007
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