Provider Demographics
NPI:1124747902
Name:TRANTALIS, CARRINA (LPC)
Entity type:Individual
Prefix:
First Name:CARRINA
Middle Name:
Last Name:TRANTALIS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 HEBRON RD
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:CT
Mailing Address - Zip Code:06232-1720
Mailing Address - Country:US
Mailing Address - Phone:860-430-0840
Mailing Address - Fax:
Practice Address - Street 1:345 HEBRON RD
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:CT
Practice Address - Zip Code:06232-1720
Practice Address - Country:US
Practice Address - Phone:860-430-0840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT46.005303101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional