Provider Demographics
NPI:1710076419
Name:MEKKELSEN, PAULA M (LCSW)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:M
Last Name:MEKKELSEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1057 POQUONNOCK RD
Mailing Address - Street 2:
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-6630
Mailing Address - Country:US
Mailing Address - Phone:860-857-8044
Mailing Address - Fax:860-437-1190
Practice Address - Street 1:1057 POQUONNOCK RD
Practice Address - Street 2:
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-6630
Practice Address - Country:US
Practice Address - Phone:860-857-8044
Practice Address - Fax:860-437-1190
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0020051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical