1902998560 NPI number — MRS. PAULETTE KAY TRUEBLOOD M.A., L.M.F.T.

Table of content: MRS. PAULETTE KAY TRUEBLOOD M.A., L.M.F.T. (NPI 1902998560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902998560 NPI number — MRS. PAULETTE KAY TRUEBLOOD M.A., L.M.F.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRUEBLOOD
Provider First Name:
PAULETTE
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
M.A., L.M.F.T.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CASTONGUAY
Provider Other First Name:
PAULETTE
Provider Other Middle Name:
KAY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1902998560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1230 S PINE CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FAIRFIELD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06824-6352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
203-255-2022
Provider Business Mailing Address Fax Number:
203-255-2512

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HARBOR RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHPORT
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06890-1316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
203-254-8262
Provider Business Practice Location Address Fax Number:
203-255-2512
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  000786 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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