Provider Demographics
NPI:1164684460
Name:MALENFANT, CAROL ANN (MS, MACP, LPC, CEDS)
Entity Type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:MALENFANT
Suffix:
Gender:F
Credentials:MS, MACP, LPC, CEDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:90 BEACH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-8060
Mailing Address - Country:US
Mailing Address - Phone:203-231-3541
Mailing Address - Fax:
Practice Address - Street 1:678 CHASE PKWY
Practice Address - Street 2:
Practice Address - City:WATERBURY
Practice Address - State:CT
Practice Address - Zip Code:06708-3050
Practice Address - Country:US
Practice Address - Phone:203-757-9357
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001635101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional