Provider Demographics
NPI:1588973267
Name:FERRARO, TERESA O (LPC)
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:O
Last Name:FERRARO
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 COTTAGE ST
Mailing Address - Street 2:
Mailing Address - City:TRUMBULL
Mailing Address - State:CT
Mailing Address - Zip Code:06611-2842
Mailing Address - Country:US
Mailing Address - Phone:203-901-4127
Mailing Address - Fax:
Practice Address - Street 1:52 HOWE ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511
Practice Address - Country:US
Practice Address - Phone:203-786-5316
Practice Address - Fax:203-786-5452
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-29
Last Update Date:2019-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004040655Medicaid