Healthcare Provider Details

I. General information

NPI: 1366228728
Provider Name (Legal Business Name): LAUREN ELIZABETH ZINKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2023
Last Update Date: 09/01/2023
Certification Date: 08/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 PECK RD STE 1212
TORRINGTON CT
06790-6123
US

IV. Provider business mailing address

14F CLAYTON RD
CANAAN CT
06018-2130
US

V. Phone/Fax

Practice location:
  • Phone: 860-361-6204
  • Fax:
Mailing address:
  • Phone: 480-252-0138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number6729
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: