Provider Demographics
NPI:1891172680
Name:MEIN, TINA MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:MEIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2911 DIXWELL AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06518-3195
Mailing Address - Country:US
Mailing Address - Phone:203-916-2488
Mailing Address - Fax:
Practice Address - Street 1:2911 DIXWELL AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06518-3195
Practice Address - Country:US
Practice Address - Phone:203-916-2488
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-30
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001540106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist