=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285797431
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHARLOTTE D LAFEMINA LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/19/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 475 S MAIN ST ROOM 3
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-271-0501
-----------------------------------------------------
Fax | 203-272-0833
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 475 S MAIN ST ROOM 3
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-271-0501
-----------------------------------------------------
Fax | 203-272-0833
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 000192
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------