Provider Demographics
NPI:1467768929
Name:IANNUCCI, CAITLIN (LPC, ATR)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:IANNUCCI
Suffix:
Gender:F
Credentials:LPC, ATR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 OXFORD RD
Mailing Address - Street 2:C1
Mailing Address - City:MILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06460-3855
Mailing Address - Country:US
Mailing Address - Phone:203-600-8900
Mailing Address - Fax:203-878-1955
Practice Address - Street 1:4 OXFORD RD
Practice Address - Street 2:C1
Practice Address - City:MILFORD
Practice Address - State:CT
Practice Address - Zip Code:06460-3855
Practice Address - Country:US
Practice Address - Phone:203-600-8900
Practice Address - Fax:203-878-1955
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-23
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor