Provider Demographics
NPI:1528285152
Name:LAFAUCI, CAROL LEE (COTA)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:LEE
Last Name:LAFAUCI
Suffix:
Gender:F
Credentials:COTA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 BRONSON RD
Mailing Address - Street 2:POB 7145
Mailing Address - City:PROSPECT
Mailing Address - State:CT
Mailing Address - Zip Code:06712-1000
Mailing Address - Country:US
Mailing Address - Phone:203-758-0230
Mailing Address - Fax:
Practice Address - Street 1:245 LONG HILL RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457-4063
Practice Address - Country:US
Practice Address - Phone:866-552-9292
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000570314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility