Provider Demographics
NPI:1447871413
Name:MISKELLA, LAURI LIN (MA, CAS, LPC)
Entity type:Individual
Prefix:
First Name:LAURI
Middle Name:LIN
Last Name:MISKELLA
Suffix:
Gender:F
Credentials:MA, CAS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 RIVERVIEW CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-2947
Mailing Address - Country:US
Mailing Address - Phone:203-339-0649
Mailing Address - Fax:
Practice Address - Street 1:1300 POST RD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6038
Practice Address - Country:US
Practice Address - Phone:203-339-0649
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-30
Last Update Date:2020-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCO7201000549103TS0200X
CT004204101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool