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NPI Code Detail

MEDICARE: JUDY T LAGASSE CADC

MEDICARE: JUDY T LAGASSE CADC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorA-3367-SACT

General Provider Information

NPI Number : 1982668000
Entity Type Code : Individual
Provider Name (Legal Business Name) : JUDY T LAGASSE CADC
Provider Business Mailing Address
First Line : 115 LAKESIDE DR
Second Line :
City : ANDOVER
State : CT
Zip : 06232-1535
Country : US
Telephone Number : 860-742-0821
Fax Number :
Provider Business Practice Location Address
First Line : 150 N MAIN ST
Second Line :
City : MANCHESTER
State : CT
Zip : 06042-2003
Country : US
Telephone Number : 860-646-1222
Fax Number : 860-647-6819
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2006
Last Update Date : 07/08/2007

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Directions to “ JUDY T LAGASSE CADC” Practice Location

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