Provider Demographics
NPI:1568977049
Name:KAPLAN GOODRICH, LARA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:LARA
Middle Name:JANE
Last Name:KAPLAN GOODRICH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 FARM VIEW DR
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-1631
Mailing Address - Country:US
Mailing Address - Phone:203-710-5081
Mailing Address - Fax:
Practice Address - Street 1:175 COPSE RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-2323
Practice Address - Country:US
Practice Address - Phone:203-245-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2017-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003517103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical