Provider Demographics
NPI:1093882508
Name:BERRAN, CAROL LYNN (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LYNN
Last Name:BERRAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:L
Other - Last Name:BERRAN-WHITMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:38 OLD RIDGEBURY RD
Mailing Address - Street 2:
Mailing Address - City:DANBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06810-5128
Mailing Address - Country:US
Mailing Address - Phone:203-743-1150
Mailing Address - Fax:203-743-1105
Practice Address - Street 1:79 PAYNE RD
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:CT
Practice Address - Zip Code:06801-1264
Practice Address - Country:US
Practice Address - Phone:203-743-1150
Practice Address - Fax:203-743-1105
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001092106H00000X
CTSA-0215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
301090OtherMHN
CT410001092CT01OtherANTHEM BLUE CROSS BLUE SH
CT004257516Medicaid