=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962936484
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAULA RAFFONE, LMFT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/12/2017
-----------------------------------------------------
Last Update Date | 04/12/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 S ELM ST 3RD FLOOR UNIT 3
-----------------------------------------------------
City | WALLINGFORD
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06492-4741
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-214-9730
-----------------------------------------------------
Fax | 203-439-2769
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 287 MOUNTAIN RD
-----------------------------------------------------
City | CHESHIRE
-----------------------------------------------------
State | CT
-----------------------------------------------------
Zip | 06410-2637
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 203-214-9730
-----------------------------------------------------
Fax | 203-439-2769
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | LMFT
-----------------------------------------------------
Name | PAULA RAFFONE
-----------------------------------------------------
Credential | MFT
-----------------------------------------------------
Telephone | 203-214-9730
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 1878
-----------------------------------------------------
License Number State | CT
-----------------------------------------------------