Provider Demographics
NPI:1962506261
Name:DEVINE, COLLEEN M (LMFT)
Entity Type:Individual
Prefix:
First Name:COLLEEN
Middle Name:M
Last Name:DEVINE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:COLLEEN
Other - Middle Name:
Other - Last Name:DEVINE, LMFT LLC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:13 LAUREN LN
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-6434
Mailing Address - Country:US
Mailing Address - Phone:860-213-1289
Mailing Address - Fax:860-381-5418
Practice Address - Street 1:2 CHAPMAN LN UNIT 12
Practice Address - Street 2:
Practice Address - City:GALES FERRY
Practice Address - State:CT
Practice Address - Zip Code:06335-1222
Practice Address - Country:US
Practice Address - Phone:860-381-5377
Practice Address - Fax:860-381-5418
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2023-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001095106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist