MEDICARE: DR. TRACEY A. LASZLOFFY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	001188	CT
2	106H00000X	Marriage & Family Therapist	LMFT-10215	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	410001188CT01	OTHER	CT	ATHEM INSURANCE

General Provider Information

NPI Number	:	1013124528
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TRACEY A. LASZLOFFY PH.D.

Provider Business Mailing Address
First Line	:	108 WASHINGTON ST UNIT G1
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-4327
Country	:	US
Telephone Number	:	704-608-7941
Fax Number	:

Provider Business Practice Location Address
First Line	:	72 NEW LONDON TPKE
Second Line	:
City	:	NORWICH
State	:	CT
Zip	:	06360-2614
Country	:	US
Telephone Number	:	704-608-7941
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	02/10/2026

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