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GLORIMAR ANDERSON
>> Organized Health Care Education/Training Program >> StudentRegistrant NPI Number: 1417469446
Individual Registrant: GLORIMAR ANDERSON
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
21 MONTAUK AVE NEW LONDON, CT 06320 US
Tel: 860-439-6400 Fax: 860-333-1390
Tel: 860-439-6400 Fax: 860-333-1390
Contact information for business:
PO BOX 390 NEW LONDON, CT 06320-0390 US
Tel: 860-271-4715 Fax: 860-333-1390
Tel: 860-271-4715 Fax: 860-333-1390
Registration Information:
NPI: 1417469446
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 390200000X | Student Organized Health Care Education/Training Program | CT | 3419 |
| Y | 1041C0700X | Behavioral Health & Social Service Providers Social Worker | CT | 10248 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
| STATE OF CONNECTICUT DPH | 3419 | CT | 01 |
| STATE OF CONNECTICUT DPH | 10248 | CT | 01 |
