Provider Demographics
NPI:1932119872
Name:CARPENOS, LORI (LMFT)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:CARPENOS
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 1:89 SHADOW LN APT B
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2819
Mailing Address - Country:US
Mailing Address - Phone:860-561-1919
Mailing Address - Fax:860-232-7780
Practice Address - Street 1:566 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-2920
Practice Address - Country:US
Practice Address - Phone:860-561-1919
Practice Address - Fax:860-232-7780
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000551106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004173142-03Medicaid
CT004173142-03Medicaid
CT251481Medicare UPIN
CTP2081588Medicare UPIN
CT072489Medicare UPIN
CT079996Medicare UPIN
CT4670292Medicare UPIN
CTCO10906Medicare UPIN