Provider Demographics
NPI:1477985802
Name:RENFRO, LAURA M (LMFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:M
Last Name:RENFRO
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 1:1100 NEW BRITAIN AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06110-2427
Mailing Address - Country:US
Mailing Address - Phone:860-493-1467
Mailing Address - Fax:860-760-6316
Practice Address - Street 1:1100 NEW BRITAIN AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06110-2427
Practice Address - Country:US
Practice Address - Phone:860-493-1467
Practice Address - Fax:860-760-6316
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000704106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist