Provider Demographics
NPI:1750970489
Name:STANCZYC, LORI A (MED, LPC, CPS, ES)
Entity type:Individual
Prefix:
First Name:LORI
Middle Name:A
Last Name:STANCZYC
Suffix:
Gender:F
Credentials:MED, LPC, CPS, ES
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W AVON RD STE 4
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:CT
Mailing Address - Zip Code:06001-2200
Mailing Address - Country:US
Mailing Address - Phone:860-614-4092
Mailing Address - Fax:
Practice Address - Street 1:395 W AVON RD STE 4
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:CT
Practice Address - Zip Code:06001-2200
Practice Address - Country:US
Practice Address - Phone:860-614-2647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-17
Last Update Date:2021-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT00600101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health