Provider Demographics
NPI:1285048330
Name:TRINIDAD, ALTAGRACIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:ALTAGRACIA
Middle Name:
Last Name:TRINIDAD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:ALTAGRACIA
Other - Middle Name:
Other - Last Name:LARA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:40 LAUREL HILL RD UNIT 308
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-1743
Mailing Address - Country:US
Mailing Address - Phone:039-474-6802
Mailing Address - Fax:
Practice Address - Street 1:40 LAUREL HILL RD UNIT 308
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804
Practice Address - Country:US
Practice Address - Phone:203-947-4680
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3652101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional