=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215464235
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | EMILY LAPRADE
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2017
-----------------------------------------------------
Last Update Date | 04/28/2021
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 172 HARRISVILLE RD
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06281-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-481-2627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 172 HARRISVILLE RD
-----------------------------------------------------
City | WOODSTOCK
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06281-3417
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 860-481-2627
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | 4425
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------