Basic Information
| Provider Information | |||||||||
| NPI: | 1255603353 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANDREA LOFTUS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 836 FARMINGTON AVE | ||||||||
| Address2: | SUITE 217B | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061191505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
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| Practice Location | |||||||||
| Address1: | 836 FARMINGTON AVE | ||||||||
| Address2: | SUITE 217B | ||||||||
| City: | WEST HARTFORD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 061191505 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8606463888 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2012 | ||||||||
| LastUpdateDate: | 02/04/2012 | ||||||||
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| AuthorizedOfficialLastName: | LOFTUS | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 8606463888 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LCSW | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 006557 | CT | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.