Provider Demographics
NPI:1528295474
Name:SMYTH, ANNA MARIE (LMFT, LADC)
Entity type:Individual
Prefix:MS
First Name:ANNA
Middle Name:MARIE
Last Name:SMYTH
Suffix:
Gender:F
Credentials:LMFT, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 THAYER AVE
Mailing Address - Street 2:
Mailing Address - City:COLLINSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06019-3023
Mailing Address - Country:US
Mailing Address - Phone:860-712-5371
Mailing Address - Fax:
Practice Address - Street 1:101 RIVER RD
Practice Address - Street 2:
Practice Address - City:COLLINSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06019-3244
Practice Address - Country:US
Practice Address - Phone:860-712-5371
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000876106H00000X
CT000560101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)