Provider Demographics
NPI:1982008462
Name:HROSTEK, LUCILLE ROSALIE (LPC)
Entity Type:Individual
Prefix:MS
First Name:LUCILLE
Middle Name:ROSALIE
Last Name:HROSTEK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:LUCILLE
Other - Middle Name:ROSALIE
Other - Last Name:JACKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SCHOOL COUNSELOR
Mailing Address - Street 1:115 NICHOLS AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-1930
Mailing Address - Country:US
Mailing Address - Phone:203-218-1664
Mailing Address - Fax:
Practice Address - Street 1:115 NICHOLS AVE
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-1930
Practice Address - Country:US
Practice Address - Phone:203-218-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-13
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001337101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional