Provider Demographics
NPI:1588318984
Name:D'ANIELLO HEYDA, CARISSA ANN (LMFT)
Entity type:Individual
Prefix:DR
First Name:CARISSA
Middle Name:ANN
Last Name:D'ANIELLO HEYDA
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CARISSA
Other - Middle Name:
Other - Last Name:D'ANIELLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:5836 88TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-3649
Mailing Address - Country:US
Mailing Address - Phone:203-605-0390
Mailing Address - Fax:
Practice Address - Street 1:5836 88TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-3649
Practice Address - Country:US
Practice Address - Phone:203-605-0390
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-05
Last Update Date:2022-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002754101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health