Provider Demographics
NPI:1386205805
Name:LAMPERT, DOUGLAS (LPC)
Entity Type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:
Last Name:LAMPERT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:DOUGLAS
Other - Middle Name:
Other - Last Name:LAMPERT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:35 TOWER LN
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-4237
Mailing Address - Country:US
Mailing Address - Phone:860-284-0048
Mailing Address - Fax:
Practice Address - Street 1:35 TOWER LN
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-4237
Practice Address - Country:US
Practice Address - Phone:860-284-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003620101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT003620OtherSTATE OF CT LPC LIC NUMBER