Provider Demographics
NPI:1699827634
Name:SISTARE, PAULA ELLEN (LPC, NCC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:ELLEN
Last Name:SISTARE
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41HARTFOD AVENUE
Mailing Address - Street 2:P. O. BOX 206
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-0206
Mailing Address - Country:US
Mailing Address - Phone:860-844-8998
Mailing Address - Fax:860-653-8077
Practice Address - Street 1:41 HARTFORD AVE.
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-0206
Practice Address - Country:US
Practice Address - Phone:860-844-8998
Practice Address - Fax:860-653-8077
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001272101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health