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General NPI Number Information
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NPI Number | 1518302041
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Entity Type | Organization
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Legal Business Name | DR. TRACEY LASZLOFFY LLC
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Dates
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Enumeration Date | 05/10/2013
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Last Update Date | 11/17/2014
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Provider Practice Location Address
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Address Line | 18 ONECO ST STE 2
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City | NORWICH
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State | CT
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Zip | 06360-3440
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Country | US
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Telephone | 704-608-7941
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Fax |
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Provider Business Mailing Address
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Address Line | 12 NEW LONDON TPKE # 196
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City | NORWICH
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State | CT
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Zip | 06360-2311
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Country | US
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Telephone | 704-608-7941
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TRACEY LASZLOFFY
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Credential | PHD
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Telephone | 704-608-7941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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