Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist |
NPI | 1003282674 |
---|---|
Provider Name | Anna Loiterstein |
First Address | Guilford, CT 06437-2473 |
Second Address | Guilford, CT 06437-2473 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2015 |
Last Update Date | 14/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
141397918 | (05) | NY |