Provider Demographics
NPI:1568742708
Name:PISANO, LAUREN B (LMFT)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:B
Last Name:PISANO
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 1:100 CENTER ST STE 205
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-4112
Mailing Address - Country:US
Mailing Address - Phone:203-936-8339
Mailing Address - Fax:
Practice Address - Street 1:100 CENTER ST STE 205
Practice Address - Street 2:
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-4112
Practice Address - Country:US
Practice Address - Phone:203-936-8339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-19
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001928106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008003522Medicaid