Healthcare Provider Details

I. General information

NPI: 1548379266
Provider Name (Legal Business Name): STEPHANIE JANE SMITH LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/29/2006
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

90 S PARK ST STE 30
WILLIMANTIC CT
06226-3336
US

IV. Provider business mailing address

71 CARD ST
WILLIMANTIC CT
06226-3217
US

V. Phone/Fax

Practice location:
  • Phone: 860-208-6436
  • Fax: 860-423-5353
Mailing address:
  • Phone: 860-208-6436
  • Fax: 860-423-5353

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number001292
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: