MEDICARE: MS. ELAINE BENTLEY BAUGHN LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	LMFT000585	CT

General Provider Information

NPI Number	:	1679656631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ELAINE BENTLEY BAUGHN LMFT

Provider Business Mailing Address
First Line	:	44R LEBANON RD
Second Line	:
City	:	BOZRAH
State	:	CT
Zip	:	06334
Country	:	US
Telephone Number	:	860-892-4088
Fax Number	:	860-376-5878

Provider Business Practice Location Address
First Line	:	44R LEBANON RD
Second Line	:
City	:	BOZRAH
State	:	CT
Zip	:	06334
Country	:	US
Telephone Number	:	860-892-4088
Fax Number	:	860-376-5878

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	07/08/2007

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