Provider Demographics
NPI:1386359636
Name:ANDERSON, KIRIANETH SUGEI
Entity type:Individual
Prefix:
First Name:KIRIANETH
Middle Name:SUGEI
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26324 TOWN WALK DR
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3774
Mailing Address - Country:US
Mailing Address - Phone:203-864-0450
Mailing Address - Fax:
Practice Address - Street 1:26324 TOWN WALK DR
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3774
Practice Address - Country:US
Practice Address - Phone:203-864-0450
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical