Provider Demographics
NPI:1841708534
Name:PISANO, LAURA MARIE (MMFT, LMFT)
Entity type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARIE
Last Name:PISANO
Suffix:
Gender:F
Credentials:MMFT, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 WALLS DR STE 206
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-5180
Mailing Address - Country:US
Mailing Address - Phone:203-689-8989
Mailing Address - Fax:
Practice Address - Street 1:55 WALLS DR STE 206
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-5180
Practice Address - Country:US
Practice Address - Phone:203-689-8989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT003145106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist