Provider Demographics
NPI:1013124528
Name:LASZLOFFY, TRACEY A (PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:A
Last Name:LASZLOFFY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 WASHINGTON ST UNIT G1
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-4327
Mailing Address - Country:US
Mailing Address - Phone:704-608-7941
Mailing Address - Fax:
Practice Address - Street 1:24 SACHEM ST FL 2
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4202
Practice Address - Country:US
Practice Address - Phone:704-608-7941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001188106H00000X
AZLMFT-10215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT410001188CT01OtherATHEM INSURANCE