Ronald Douglas Anderson, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

001296 Issued in CT

Practice address

21 Church St
Willimantic, CT 06226-2644

Phone

(860) 456-4442

NPI assigned

Jun 16, 2005

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in CT

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118880000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1679578686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 301",
            "city": "MANSFIELD CENTER",
            "state": "CT",
            "postal_code": "062500301",
            "telephone_number": "860-487-1641",
            "fax_number": "860-456-4068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21 CHURCH ST",
            "city": "WILLIMANTIC",
            "state": "CT",
            "postal_code": "062262644",
            "telephone_number": "860-456-4442"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDERSON",
        "first_name": "RONALD",
        "middle_name": "DOUGLAS",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CT",
            "license": "001296",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM /BLUE CROSS",
            "identifier": "0600001296CT03",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jerilyn S Allen, MD
• Nathan R Allen, LMSW
• Fernando Luis Almenas, M.D.
• Tara M Alosky
• Kara Elizabeth Anastasiou, APRN-BC
• Anesthesia Associates of Willimantic PC
• Carol Jean Annino, DO
• Lisa M Annunziato
• Naida E. Arcenas, APRN
• Raelene Asselin

• Clinical Psychologist in Willimantic, CT
• Providers in Willimantic, CT by specialty
• Clinical Psychologist in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.