Provider Demographics
NPI:1790091387
Name:LAUTERBACH, ELENOR CARINE (LCSW)
Entity Type:Individual
Prefix:
First Name:ELENOR
Middle Name:CARINE
Last Name:LAUTERBACH
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 1:1 PARK ST
Mailing Address - Street 2:HSC
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851-4841
Mailing Address - Country:US
Mailing Address - Phone:203-849-1111
Mailing Address - Fax:
Practice Address - Street 1:176 STRAWBERRY HILL AVE
Practice Address - Street 2:NATHAN HALE MIDDLE SCHOOL
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-5937
Practice Address - Country:US
Practice Address - Phone:203-899-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical