Provider Demographics
NPI:1053033035
Name:D'ANDREA, ALISA LAYLA (MFTA)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:LAYLA
Last Name:D'ANDREA
Suffix:
Gender:F
Credentials:MFTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 MATHER ST
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06517-2411
Mailing Address - Country:US
Mailing Address - Phone:203-430-2178
Mailing Address - Fax:
Practice Address - Street 1:1884 WHITNEY AVE
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06517-1205
Practice Address - Country:US
Practice Address - Phone:203-407-1310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2024-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003309106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist