Healthcare Provider Details

I. General information

NPI: 1699700831
Provider Name (Legal Business Name): STEPHEN P PASCHALL LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44 MARLBOROUGH TURNPIKE PATH
PORTLAND CT
06480
US

IV. Provider business mailing address

675 TOWER AVENUE SUITE 301
HARTFORD CT
06112
US

V. Phone/Fax

Practice location:
  • Phone: 860-714-2750
  • Fax: 860-714-8591
Mailing address:
  • Phone: 860-714-2750
  • Fax: 860-714-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number501
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: