Basic Information
| Provider Information | |||||||||
| NPI: | 1902998560 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TRUEBLOOD | ||||||||
| FirstName: | PAULETTE | ||||||||
| MiddleName: | KAY | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.A., L.M.F.T. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | CASTONGUAY | ||||||||
| OtherFirstName: | PAULETTE | ||||||||
| OtherMiddleName: | KAY | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1230 S PINE CREEK RD | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068246352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032552022 | ||||||||
| FaxNumber: | 2032552512 | ||||||||
| Practice Location | |||||||||
| Address1: | 101 HARBOR RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHPORT | ||||||||
| State: | CT | ||||||||
| PostalCode: | 068901316 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2032548262 | ||||||||
| FaxNumber: | 2032552512 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/29/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | Y | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 000786 | CT | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.