MEDICARE: MR. JOSEPH TRAHAN LPC

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	101YP2500X	Professional Counselor	004587	CT

General Provider Information

NPI Number	:	1184223323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOSEPH TRAHAN LPC

Provider Business Mailing Address
First Line	:	194 ENO AVE
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-5661
Country	:	US
Telephone Number	:	860-806-1114
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 MIGEON AVE
Second Line	:
City	:	TORRINGTON
State	:	CT
Zip	:	06790-4861
Country	:	US
Telephone Number	:	860-806-1114
Fax Number	:

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

Provider Enumeration Date	:	10/20/2020
Last Update Date	:	10/20/2020

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