Healthcare Provider Details

I. General information

NPI: 1093086860
Provider Name (Legal Business Name): PAUL AREVALO LADC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/25/2012
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 CRESCENT ST
STAMFORD CT
06906-1816
US

IV. Provider business mailing address

13 EDMOND ST
DARIEN CT
06820-3111
US

V. Phone/Fax

Practice location:
  • Phone: 203-219-5133
  • Fax:
Mailing address:
  • Phone: 203-219-5133
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number000863
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number000863
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: