Individual
MS. STEPHANIE JANE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
90 S PARK ST STE 30, WILLIMANTIC, CT 06226-3336
(860) 208-6436
(860) 423-5353
Mailing address
71 CARD ST, WILLIMANTIC, CT 06226-3217
(860) 208-6436
(860) 423-5353
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
001292
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
004258035
EDS CT MED ASSIST PROGRAM
CT
01
—
11244656
CAQH
CT
01
—
240001292CT01
ANTHEM BCBS
CT
01
—
322796
MHN
—
Enumeration date
08/29/2006
Last updated
12/03/2025
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