Provider Demographics
NPI:1063608214
Name:COLE, ANISA S (MSW)
Entity type:Individual
Prefix:MS
First Name:ANISA
Middle Name:S
Last Name:COLE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P34 MILL POND RD
Mailing Address - Street 2:
Mailing Address - City:BROAD BROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06016-9119
Mailing Address - Country:US
Mailing Address - Phone:413-519-8302
Mailing Address - Fax:
Practice Address - Street 1:995 DAY HILL RD
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-1722
Practice Address - Country:US
Practice Address - Phone:860-731-5522
Practice Address - Fax:860-731-5537
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health