Individual
DR. LISA GAUTHIER MICELI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
400 BAYONET ST STE 304, NEW LONDON, CT 06320-2600
(860) 443-7505
(860) 444-8895
Mailing address
100 GLENWOOD AVE, NEW LONDON, CT 06320-4350
(860) 444-7322
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
002284
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004243713
—
CT
01
—
060002284CT02
ANTHEM BEHAVIORAL HEALTH
CT
01
—
304903
MHN
CT
Enumeration date
01/02/2007
Last updated
07/08/2007
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