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General NPI Number Information
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NPI Number | 1134338049
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Entity Type | Organization
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Legal Business Name | LORRAINE LA VIGNE
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Dates
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Enumeration Date | 05/21/2007
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Last Update Date | 11/18/2009
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Provider Practice Location Address
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Address Line | 55 E CEDAR ST
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City | NEWINGTON
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State | CT
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Zip | 06111-2533
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Country | US
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Telephone | 860-665-0184
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Fax | 860-665-0532
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Provider Business Mailing Address
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Address Line | 55 E CEDAR ST
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City | NEWINGTON
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State | CT
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Zip | 06111-2533
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Country | US
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Telephone | 860-665-0184
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Fax | 860-665-0532
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. LORRAINE CATHERINE LA VIGNE
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Credential | MFT
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Telephone | 860-665-0184
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 000399
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License Number State | CT
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