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General NPI Number Information
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NPI Number | 1902998560
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Entity Type | Individual
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Provider Name | PAULETTE KAY TRUEBLOOD M.A., L.M.F.T.
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Gender | Female
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Dates
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Enumeration Date | 09/29/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 101 HARBOR RD
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City | SOUTHPORT
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State | CT
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Zip | 06890-1316
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Country | US
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Telephone | 203-254-8262
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Fax | 203-255-2512
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Provider Business Mailing Address
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Address Line | 1230 S PINE CREEK RD
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City | FAIRFIELD
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State | CT
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Zip | 06824-6352
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Country | US
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Telephone | 203-255-2022
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Fax | 203-255-2512
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 000786
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License Number State | CT
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