Provider Demographics
NPI:1811654056
Name:BELANGER, DEBRA ANN (MA, LMFT)
Entity type:Individual
Prefix:
First Name:DEBRA
Middle Name:ANN
Last Name:BELANGER
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 391
Mailing Address - Street 2:
Mailing Address - City:CENTRAL VILLAGE
Mailing Address - State:CT
Mailing Address - Zip Code:06332
Mailing Address - Country:US
Mailing Address - Phone:203-256-1919
Mailing Address - Fax:
Practice Address - Street 1:732 KINGS HIGHWAY WEST
Practice Address - Street 2:
Practice Address - City:SOUTHPORT
Practice Address - State:CT
Practice Address - Zip Code:06890
Practice Address - Country:US
Practice Address - Phone:203-257-6215
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-23
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000488106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist