Provider Demographics
NPI:1962617571
Name:PAPE-DAVIS, CARLENE E (LADC,CAC,CCDP)
Entity type:Individual
Prefix:
First Name:CARLENE
Middle Name:E
Last Name:PAPE-DAVIS
Suffix:
Gender:F
Credentials:LADC,CAC,CCDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-2601
Mailing Address - Country:US
Mailing Address - Phone:860-454-0657
Mailing Address - Fax:
Practice Address - Street 1:85 JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-2601
Practice Address - Country:US
Practice Address - Phone:860-527-1124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT697101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)