Individual
LAURA STAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, LMFT
Contact information
Practice address
949 BRIDGEPORT AVE, MILFORD, CT 06460-3142
(203) 878-6365
Mailing address
949 BRIDGEPORT AVE, MILFORD, CT 06460-3142
(203) 878-6365
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
001154
CT
106H00000X
Marriage & Family Therapist
000866
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
240001154CT01
ANTHEM PROVIDER NUMBER
CT
01
—
340269
MHN PROVIDER NUMBER
CT
01
—
410000866CT01
ANTHEM PROVIDER NUMBER
CT
Enumeration date
07/13/2006
Last updated
04/15/2008
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