Provider Demographics
NPI:1801220157
Name:DELFOSSE, CAROL ELIZABETH (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:ELIZABETH
Last Name:DELFOSSE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:CAROL
Other - Middle Name:ELIZABETH
Other - Last Name:GRAVELLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5543 E CHERYL PKWY
Mailing Address - Street 2:
Mailing Address - City:FITCHBURG
Mailing Address - State:WI
Mailing Address - Zip Code:53711-5376
Mailing Address - Country:US
Mailing Address - Phone:608-274-4224
Mailing Address - Fax:
Practice Address - Street 1:5543 E CHERYL PKWY
Practice Address - Street 2:
Practice Address - City:FITCHBURG
Practice Address - State:WI
Practice Address - Zip Code:53711-5376
Practice Address - Country:US
Practice Address - Phone:608-274-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist