Provider Demographics
NPI:1962692004
Name:LOPRESTI, ANNE MARIE MAIRE (LCSW)
Entity type:Individual
Prefix:MS
First Name:ANNE MARIE
Middle Name:MAIRE
Last Name:LOPRESTI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1635 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06610
Mailing Address - Country:US
Mailing Address - Phone:203-394-6529
Mailing Address - Fax:203-395-6534
Practice Address - Street 1:100 FAIRFIELD AVE
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06604-4239
Practice Address - Country:US
Practice Address - Phone:203-394-6529
Practice Address - Fax:203-395-6534
Is Sole Proprietor?:No
Enumeration Date:2007-07-25
Last Update Date:2014-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CT0071111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039251Medicaid