Provider Demographics
NPI:1629709290
Name:IERACI, PATRICIA AGNES (LPCA)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:AGNES
Last Name:IERACI
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 LYDALE PL
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6100
Mailing Address - Country:US
Mailing Address - Phone:860-874-1284
Mailing Address - Fax:
Practice Address - Street 1:670 MAIN ST S
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:CT
Practice Address - Zip Code:06798-3738
Practice Address - Country:US
Practice Address - Phone:203-263-3175
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-23
Last Update Date:2022-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5587101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional