Provider Demographics
NPI:1396008108
Name:LACZAK, PETER C (LMFT)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:C
Last Name:LACZAK
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:540 LITCHFIELD ST
Mailing Address - Street 2:C/O ROSA PAGANO
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6679
Mailing Address - Country:US
Mailing Address - Phone:860-496-6361
Mailing Address - Fax:860-496-6389
Practice Address - Street 1:540 LITCHFIELD ST
Practice Address - Street 2:C/O ROSA PAGANO
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-6679
Practice Address - Country:US
Practice Address - Phone:860-496-6361
Practice Address - Fax:860-496-6389
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001843106H00000X
CT390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program