=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508976218
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RENEE EVELYN STRAINGE LMFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/30/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3300 MAIN ST FAMILY RESOURCE ASSOC
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-378-4514
-----------------------------------------------------
Fax | 203-378-0443
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3300 MAIN ST FAMILY RESOURCE ASSOC
-----------------------------------------------------
City | STRATFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06614
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-378-4514
-----------------------------------------------------
Fax | 208-378-0443
-----------------------------------------------------
=====================================================
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 | 000539
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------