Provider Demographics
NPI:1154347037
Name:MORELLI, ANTHONY ALLEN (LCSW)
Entity type:Individual
Prefix:MR
First Name:ANTHONY
Middle Name:ALLEN
Last Name:MORELLI
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:POMFRET CENTER
Mailing Address - State:CT
Mailing Address - Zip Code:06259-0143
Mailing Address - Country:US
Mailing Address - Phone:959-444-1434
Mailing Address - Fax:484-450-4380
Practice Address - Street 1:144 MURDOCK RD
Practice Address - Street 2:
Practice Address - City:POMFRET CENTER
Practice Address - State:CT
Practice Address - Zip Code:06259-9992
Practice Address - Country:US
Practice Address - Phone:959-444-1434
Practice Address - Fax:484-450-4380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2023-02-06
Deactivation Date:2022-09-25
Deactivation Code:
Reactivation Date:2023-02-06
Provider Licenses
StateLicense IDTaxonomies
CT0046731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008046918Medicaid