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Individual

MISS LORY SETA JOLOLIAN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F
Credential
LPC

Contact information

Practice address
226 DIXWELL AVENUE, NORTHSIDE COMMUNITY OUTPATIENT SERVICES, NEW HAVEN, CT 06511-3456
(203) 503-3470
(203) 503-3478
Mailing address
400 COLUMBUS AVENUE, CREDENTIALING SPECIALIST, NEW HAVEN, CT 06519-1233
(203) 503-3174
(203) 503-6515

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
007844
NY
101YP2500X
Professional Counselor
Primary
3657
CT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
004235918
CT
Enumeration date
03/30/2017
Last updated
02/28/2019
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