Provider Demographics
NPI:1750408605
Name:DEAFENBAUGH, PAULA ANNE (LPC)
Entity type:Individual
Prefix:
First Name:PAULA
Middle Name:ANNE
Last Name:DEAFENBAUGH
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 1:10 LONGVIEW TER
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:CT
Mailing Address - Zip Code:06443-3409
Mailing Address - Country:US
Mailing Address - Phone:203-245-7238
Mailing Address - Fax:203-245-0614
Practice Address - Street 1:10 LONGVIEW TER
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:CT
Practice Address - Zip Code:06443-3409
Practice Address - Country:US
Practice Address - Phone:203-376-7414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-24
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT000147OtherLICENSE