Provider Demographics
NPI:1720690142
Name:MILFORT, MYRIAM (LPC)
Entity Type:Individual
Prefix:MS
First Name:MYRIAM
Middle Name:
Last Name:MILFORT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 LOCKWOOD AVENUE
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902
Mailing Address - Country:US
Mailing Address - Phone:203-399-4096
Mailing Address - Fax:203-781-4624
Practice Address - Street 1:155 LOCKWOOD AVENUE
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902
Practice Address - Country:US
Practice Address - Phone:203-399-4096
Practice Address - Fax:203-781-4624
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.004567101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004082260Medicaid
CT008001325Medicaid
CT008022622Medicaid
CT008097533Medicaid