Individual
TERRI EBLEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
949 BRIDGEPORT AVE, MILFORD, CT 06460-3142
(203) 878-6365
Mailing address
1944 LITCHFIELD TPKE, WOODBRIDGE, CT 06525-1251
(203) 387-3417
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
000103
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
191073
MHN PROVIDER NUMBER
CT
Enumeration date
06/20/2006
Last updated
07/09/2007
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