Provider Demographics
NPI:1801341938
Name:IOSIFIDIS, MEGAN (MS)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:IOSIFIDIS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 ANSMOUR RD
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:CT
Mailing Address - Zip Code:06483-2401
Mailing Address - Country:US
Mailing Address - Phone:207-754-9612
Mailing Address - Fax:
Practice Address - Street 1:1 ANSMOUR RD
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:CT
Practice Address - Zip Code:06483-2401
Practice Address - Country:US
Practice Address - Phone:207-754-9612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2022-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003313101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional