Healthcare Provider Details

I. General information

NPI: 1326792912
Provider Name (Legal Business Name): AUTUMN CHASE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 PARK CIR
MILFORD CT
06460-4832
US

IV. Provider business mailing address

34 PARK CIR
MILFORD CT
06460-4832
US

V. Phone/Fax

Practice location:
  • Phone: 860-906-2147
  • Fax:
Mailing address:
  • Phone: 860-906-2147
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6255
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: