Provider Demographics
NPI:1285714659
Name:STUART-THOMS, ELAINE (MA, LPC)
Entity type:Individual
Prefix:
First Name:ELAINE
Middle Name:
Last Name:STUART-THOMS
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:CT
Mailing Address - Zip Code:06035-1418
Mailing Address - Country:US
Mailing Address - Phone:860-653-0682
Mailing Address - Fax:860-653-0682
Practice Address - Street 1:25 W LAKEVIEW DR
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:CT
Practice Address - Zip Code:06035-1418
Practice Address - Country:US
Practice Address - Phone:860-653-0682
Practice Address - Fax:860-653-0682
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT62-97542OtherUNITED BEHAVIORAL HEALTH
CTP2807741OtherOXFORD BEHAVIORAL HEALTH
CTN107BOtherEMPIRE BLUE CROSS
CT240000492CT02OtherANTHEM BLUE CROSS, BLUE S