# LAURA PETIFORD PMHNP, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1083110092
- **Authorized official:** LAURA PETIFORD PMHNP (MEMBER)
- **Authorized official phone:** (203) 445-6238

## Contact information

- **Practice address:** 1525 KINGS HWY STE 206, FAIRFIELD, CT 06824-5321
- **Practice address phone:** (203) 445-6238
- **Practice address fax:** (203) 844-0179
- **Mailing address:** 1525 KINGS HWY STE 206, FAIRFIELD, CT 06824-5321

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363LP0808X | Psychiatric/Mental Health Nurse Practitioner | 006417 | CT | Yes |

## Other

- **Enumeration date:** 03/30/2018
- **Last updated:** 03/30/2018