Provider Demographics
NPI:1225430333
Name:GORMAN, CAROLYN MAY (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:MAY
Last Name:GORMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:CAROLYN
Other - Middle Name:MAY
Other - Last Name:BURGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:133 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3169
Mailing Address - Country:US
Mailing Address - Phone:860-834-1312
Mailing Address - Fax:
Practice Address - Street 1:341 WEST ST UNIT B
Practice Address - Street 2:
Practice Address - City:PLANTSVILLE
Practice Address - State:CT
Practice Address - Zip Code:06479-1140
Practice Address - Country:US
Practice Address - Phone:203-819-0789
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-19
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002318101YP2500X, 101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional