Provider Demographics
NPI:1619407541
Name:SPERA, LAURYL (LPC, LADC)
Entity Type:Individual
Prefix:
First Name:LAURYL
Middle Name:
Last Name:SPERA
Suffix:
Gender:F
Credentials:LPC, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 HALEY RD
Mailing Address - Street 2:
Mailing Address - City:LEDYARD
Mailing Address - State:CT
Mailing Address - Zip Code:06339-1919
Mailing Address - Country:US
Mailing Address - Phone:860-501-1075
Mailing Address - Fax:
Practice Address - Street 1:2 CHAPMAN LN STE B
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1200
Practice Address - Country:US
Practice Address - Phone:860-501-1075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-13
Last Update Date:2017-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001024101YA0400X
CT002315101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)