Provider Demographics
NPI:1912200023
Name:HENNESSEY, PAULA C (LADC)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:C
Last Name:HENNESSEY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:192 SOUTH MAIN STREET
Mailing Address - Street 2:REAR ENTRANCE
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:203-379-6403
Mailing Address - Fax:860-788-6777
Practice Address - Street 1:192 S MAIN ST
Practice Address - Street 2:REAR ENTRANCE
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-3727
Practice Address - Country:US
Practice Address - Phone:203-379-6403
Practice Address - Fax:860-788-6777
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor