Provider Demographics
NPI:1629307608
Name:SLOATE, GEORGIANNA (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:GEORGIANNA
Middle Name:
Last Name:SLOATE
Suffix:
Gender:F
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 S STREET EXT
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6416
Mailing Address - Country:US
Mailing Address - Phone:860-205-3672
Mailing Address - Fax:
Practice Address - Street 1:38 KELLEY ST
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-5715
Practice Address - Country:US
Practice Address - Phone:860-314-1236
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-21
Last Update Date:2009-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001354106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist