Provider Demographics
NPI:1407580129
Name:GRULLON CEPEDA, LADYLANIS DEL CARMEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LADYLANIS
Middle Name:DEL CARMEN
Last Name:GRULLON CEPEDA
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 1:33 GODAR TER
Mailing Address - Street 2:
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06118-1926
Mailing Address - Country:US
Mailing Address - Phone:860-912-1821
Mailing Address - Fax:
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-2007
Practice Address - Country:US
Practice Address - Phone:860-643-2101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-11
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7064101YM0800X
CT5649101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health