Provider Demographics
NPI:1427341106
Name:MITCHELL-VARNUM, BARBARA JEAN (MS, CAGS LPC)
Entity type:Individual
Prefix:MRS
First Name:BARBARA
Middle Name:JEAN
Last Name:MITCHELL-VARNUM
Suffix:
Gender:F
Credentials:MS, CAGS LPC
Other - Prefix:MRS
Other - First Name:BARBARA
Other - Middle Name:JEAN
Other - Last Name:VARNUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:20 HOADLY RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1509
Mailing Address - Country:US
Mailing Address - Phone:860-228-8790
Mailing Address - Fax:
Practice Address - Street 1:20 HOADLY RD
Practice Address - Street 2:
Practice Address - City:AMSTON
Practice Address - State:CT
Practice Address - Zip Code:06231-1509
Practice Address - Country:US
Practice Address - Phone:860-228-8790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12244010OtherCAQH