=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912100934
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MICHAEL STEPHEN DELAURO L.M.F.T.
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2007
-----------------------------------------------------
Last Update Date | 12/30/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2514 BOSTON POST RD SUITE 8 C
-----------------------------------------------------
City | GUILFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06437-1338
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-314-9078
-----------------------------------------------------
Fax | 209-579-3693
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 FALLS BASHAN RD
-----------------------------------------------------
City | MOODUS
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06469-1231
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-314-9078
-----------------------------------------------------
Fax | 203-579-3693
-----------------------------------------------------
=====================================================
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 | 001043
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------