Provider Demographics
NPI:1063870186
Name:FALCONIERI, STEPHEN (LPC,LADC)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:FALCONIERI
Suffix:
Gender:M
Credentials:LPC,LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:67 HIGH ST
Mailing Address - Street 2:
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-3120
Mailing Address - Country:US
Mailing Address - Phone:203-228-2606
Mailing Address - Fax:
Practice Address - Street 1:12 CURTIS ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5900
Practice Address - Country:US
Practice Address - Phone:203-228-2606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-03
Last Update Date:2019-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTLADC-1279101YA0400X
CTCAC-4459101YA0400X
CT1279101YA0400X
CTLPC-3740101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)