Provider Demographics
NPI: | 1114916574 |
---|---|
Name: | TAYLOR-AUSTIN, LISA A (NCC, LPC, LMHC, CFMH) |
Entity Type: | Individual |
Prefix: | MS |
First Name: | LISA |
Middle Name: | A |
Last Name: | TAYLOR-AUSTIN |
Suffix: | |
Gender: | F |
Credentials: | NCC, LPC, LMHC, CFMH |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 415 BOSTON POST RD STE 3-1118 |
Mailing Address - Street 2: | |
Mailing Address - City: | MILFORD |
Mailing Address - State: | CT |
Mailing Address - Zip Code: | 06460-2578 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 203-522-6164 |
Mailing Address - Fax: | 855-855-1870 |
Practice Address - Street 1: | 57 PLAINS RD |
Practice Address - Street 2: | SUITE 2C |
Practice Address - City: | MILFORD |
Practice Address - State: | CT |
Practice Address - Zip Code: | 06461-2573 |
Practice Address - Country: | US |
Practice Address - Phone: | 203-522-6164 |
Practice Address - Fax: | 203-878-3228 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2005-10-18 |
Last Update Date: | 2024-02-26 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
CT | 001282 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
CT | 240001282CT02 | Other | ANTHEM |
CT | 108346 | Other | UBH |
CT | 60054 | Other | AETNA |
CT | 291145000 | Other | MAGELLAN |
CT | 264405 | Other | MHN |