Provider Demographics
NPI:1417380981
Name:TOMASELLI, DEBRA L (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:L
Last Name:TOMASELLI
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2296 MAIN STREET
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:STRATFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06615
Mailing Address - Country:US
Mailing Address - Phone:203-645-1677
Mailing Address - Fax:203-377-4946
Practice Address - Street 1:2296 MAIN STREET
Practice Address - Street 2:2ND FLOOR
Practice Address - City:STRATFORD
Practice Address - State:CT
Practice Address - Zip Code:06615
Practice Address - Country:US
Practice Address - Phone:203-645-1677
Practice Address - Fax:203-377-4946
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-19
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001558106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist