Healthcare Provider Details

I. General information

NPI: 1023352887
Provider Name (Legal Business Name): EBONY RAINGE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/19/2012
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

949 BRIDGEPORT AVE
MILFORD CT
06460-3142
US

IV. Provider business mailing address

949 BRIDGEPORT AVE
MILFORD CT
06460-3142
US

V. Phone/Fax

Practice location:
  • Phone: 203-878-6365
  • Fax: 203-301-2397
Mailing address:
  • Phone: 203-878-6365
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number9162
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: