Provider Demographics
NPI:1417398306
Name:PASSMORE, CAROL A (LPC)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:A
Last Name:PASSMORE
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 1:45 SHERMAN ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5821
Mailing Address - Country:US
Mailing Address - Phone:203-993-4094
Mailing Address - Fax:
Practice Address - Street 1:45 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5821
Practice Address - Country:US
Practice Address - Phone:203-993-4094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2013-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001852101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional