Provider Demographics
NPI:1194879155
Name:GURR, JOHANNA ANNE (MS LPC)
Entity type:Individual
Prefix:MRS
First Name:JOHANNA
Middle Name:ANNE
Last Name:GURR
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:JOHANNA
Other - Middle Name:ANNE
Other - Last Name:BIALASK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:52 BEAVER STREET
Mailing Address - Street 2:
Mailing Address - City:HAMDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06514
Mailing Address - Country:US
Mailing Address - Phone:203-562-8728
Mailing Address - Fax:
Practice Address - Street 1:60 CONNOLLY PARKWAY
Practice Address - Street 2:
Practice Address - City:HAMDEN
Practice Address - State:CT
Practice Address - Zip Code:06514
Practice Address - Country:US
Practice Address - Phone:203-562-8728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000161101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional