Provider Demographics
NPI:1124208350
Name:FREGEAU, EILEEN M (LPC)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:M
Last Name:FREGEAU
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:159 E MAIN ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BRANFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06405-3784
Mailing Address - Country:US
Mailing Address - Phone:203-488-0149
Mailing Address - Fax:
Practice Address - Street 1:805 EDGEWOOD AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-2216
Practice Address - Country:US
Practice Address - Phone:203-387-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001636101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional